91: Treatment of Mucous Cysts of the Distal Interphalangeal Joint

Published on 18/04/2015 by admin

Filed under Surgery

Last modified 18/04/2015

Print this page

rate 1 star rate 2 star rate 3 star rate 4 star rate 5 star
Your rating: none, Average: 0 (0 votes)

This article have been viewed 2409 times

Procedure 91 Treatment of Mucous Cysts of the Distal Interphalangeal Joint

Shimpei Ono, Sandeep J. Sebastin, Kevin C. Chung

Indications

image Symptomatic mucous cyst

• Progressive cyst with impending rupture due to thinning of skin (Fig. 91-1)
• Discomfort or pain due to pressure from the cyst
• Nail deformity (see Fig. 91-1)

image Asymptomatic mucous cyst

• Aesthetic appearance
• Patient desire

image Patients should be advised that cyst excision might not provide complete pain relief in the context of an underlying arthritic joint because pain can be due to either the cyst or the underlying arthritic joint. The only treatment that can ensure a cyst will not recur is distal interphalangeal (DIP) joint arthrodesis.

image

FIGURE 91-1

Examination/Imaging

Clinical Examination

image A mucous cyst is a degenerative cyst of the DIP joint arising as a result of osteoarthritis. It usually occurs between the fifth and seventh decades of life, and patients have DIP joint osteoarthritis including Heberden nodes (Fig. 91-2).

image The cyst may present on the dorsum at the level of the DIP joint on either side between the extensor tendon and the collateral ligament or under the eponychium to cause longitudinal grooving of the nail plate (Fig. 91-3).

image

FIGURE 91-2

image

FIGURE 91-3

Imaging

image Anteroposterior and lateral view radiographs are useful in determining the location of the osteophytes and degree of osteoarthritic change (joint subluxation, deformity, and joint space narrowing) (Fig. 91-4).

image

FIGURE 91-4

Surgical Anatomy

image The mucous cyst originates from the DIP joint in relation to one of the osteophytes, and the stalk of the cyst passes between the collateral ligament and the extensor insertion to present on the dorsum of the DIP joint. Occasionally, the stalk can connect with another mucous cyst on the opposite side of the DIP joint. This cyst may not be clinically obvious (occult cyst), and the entire DIP joint should be examined during surgery.

image The terminal extensor insertion is about 1.2 mm from the proximal edge of the nail matrix (Fig. 91-5).

image

FIGURE 91-5

Positioning

image The procedure can be performed under a digital block using a forearm, arm, or digital tourniquet.

Buy Membership for Surgery Category to continue reading. Learn more here

Related posts:

81: Ulnar Shortening Osteotomy 93: Digital Ray Amputation 21: Steindler Flexorplasty 50: Open Reduction and Internal Fixation of Phalangeal Shaft Comminuted Fractures 21: Steindler Flexorplasty 37: Duplicated Thumb Reconstruction