What is a mucoid cyst?

    Mucoid cysts are protrusions of the finger and thumb end joints at the onset of wear of the finger end joint or the toes. The cysts have a cavity filled with a gelatinous yellowish fluid. The mucoid dorsal cyst appears as a cherry pit-sized, hard, benign growth that shines through the overlying skin. The swelling feels plump and elastic. It is a small, (benign) tumor. This type of ganglion is most often found on the extensor side of the finger end joints. Most often, such a ganglion develops on the middle finger, index finger and thumb of the leading hand. Mucoid cysts occur in 75% of cases in women, usually between the ages of forty and seventy. There is always a connection to the affected joint of the end of the finger. Essentially, the fluid contained consists of hyaluronic acid, which is produced by fibroblasts. The filled mucoid cyst is also called pseudocyst or (mucoid) dorsal cyst in the literature. Pressure and shear forces in the distal phalanx are thought to be possible causes of mucoid cysts. Mucoid dorsal cysts often occur with bony attachments at the terminal joint, called Heberden nodes. Heberden’s arthritis is an idiopathic arthritis of the finger at the terminal joint. Bouchard’s arthritis, on the other hand, affects the middle joints of the fingers.

    An aesthetic impairment due to the swelling and disturbance of the nail growth are usually the reason for a visit to the doctor. Symptoms such as mild to severe pain or restriction of movement are less common. However, in about thirty percent of patients the nail is deformed. The deformation of the fingernail usually recedes after a medical surgical procedure. If there is a painful restriction of movement of the finger end joint, the dermatology specialist or, in the best case, the hand surgeon recommends an X-ray examination.

    What’s a digital mucous cyst?

    Mucous cysts are benign cysts of the joint of the finger next to the nail. If the finger end joints wear out, more joint fluid is formed. The fluid can lead to a protrusion of the joint skin. The cyst appears as a swelling on the back of the finger. If the cyst presses on the nail bed or the nail root it can come to a deformation of the nail. If the cause of cyst formation, i.e. joint wear, remains, the cyst can recur. Painful joint degeneration can be treated by stiffening the finger end joint. If the cyst is opened, there is a risk of serious joint inflammation.

    How is the removal of the mucous cyst performed?

    For an optimal gentle surgical technique and to minimize blood loss and is operated in finger blood empty. The thinned skin is removed in the form of a spindle. The removal of the stalk requires careful preparation of the cyst stalk between the collateral ligament and the extensor tendon. Smaller vessels are sclerosed using the bipolar technique. The cyst is removed. Disturbing bone attachments (osteophytes) are smoothed out. As a rule, a displacement of the adjacent tissue (flap plasty) is necessary. The adjacent tissue is loosened in order to achieve a tension-free closure of the wound in the flexion position. For a displacement to be successful, the tissue on the back of the finger must be cut over a large area.

    The success of the treatment is not only measured by a low recurrence rate. A local tissue displacement (flap plastic surgery) tends to allow a faster healing process of the wound with less risk of inflammation. Stiffening is recommended in cases of pain and restrictions in the mobility of the end joint. The stiffening of the end joint reliably excludes recurrence. The limitations caused by stiffening of the small joint are negligible in the case of a mobile middle and base joint.

    Removal of mucoid cysts of the finger end joint prevents spontaneous opening and allows correction of mild to severe deformity of the nail. Accidental opening of the dorsal cyst, for example during gardening, is associated with a high risk of inflammation. Inflammation of an injured mucoid cyst can lead to severe joint inflammation. The surgical procedure can preserve mobility. The risk of recurrence of a dorsal cyst after removal in the form of surgery is low. Of course, immobilization of the finger is necessary after the operation. The other fingers are not affected by the restriction of movement. The treating surgeon will explain this to you in detail, answer all your questions and give you further information.

    Are there alternatives to surgery for a mucoid cyst?

    A variety of treatments with very different chances of success have been described, from radiotherapy to chemical burns. Nowadays it is considered obsolete to pierce and absorb the fluid with a hollow needle. After a puncture, a cyst reappears in thirty to one hundred percent of cases. In addition, there is a high risk of inflammation. Due to the lower frequency of recurrence, surgical removal has become established.

    How can you prepare for the removal of the mucoid cyst?

    • Questions on your part regarding a possible complication and alternative treatments should be answered before the surgery appointment.
    • In any case, limit your alcohol and nicotine consumption to a minimum.
    • You must discontinue blood-thinning medications such as ASS and Thomapyrin® at least 10 days prior to mucoid cyst surgery (after consultation with your treating physician).
    • Vitamin preparations (A, E) and dietary supplements (omega-3 fatty acids, St. John’s wort preparations, etc.) must be stopped four weeks before the operation.
    • Surgical procedures limit fitness for air travel. Therefore, do not plan any air travel (either business or private) in the four weeks following the operation.
    • At home, prepare ice cubes or cooling pads to cool your skin after the operation.

    What do you need to consider after the removal of a mucoid cyst?

    • Your well-being and the outcome of the operation will be monitored regularly.
    • The elevation and cooling of the hand during the first three days promotes swelling reduction and wound healing.
    • Perform complete fist closure and finger extension exercises several times per hour.
    • From the 3rd postoperative week onwards, massaging for a few minutes several times a day helps to make the scars inconspicuous. Use greasing creams (e.g. Bepanthen® ointment or Linola® fat) and always massage in circles as well as lengthwise & crosswise to the course of the scar.
    • The skin threads are removed after ten to fourteen days.
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    The author

    Dr. med. Stéphane Stahl

    “We provide you with extensive expert knowledge so that we can work with you to select the best possible treatment path.”

    Dr. med. Stéphane steel is the former director of the Clinic for Plastic, Reconstructive and Aesthetic Surgery / Hand Surgery at the Lüdenscheid Clinic. Dr. Stahl studied medicine at the Universities of Freiburg and Berlin. In 2011 he passed the European and 2012 the German specialist examination for plastic and aesthetic surgery. Further specialist qualifications and additional qualifications followed (including quality management, medical didactics, physical therapy, emergency medicine, laser protection officers, hand surgery) as well as prizes and awards. In 2015 he completed his habilitation in plastic and aesthetic surgery in Tübingen. He is an experienced microsurgeon, a sought-after expert and a regular speaker at specialist congresses. After a multi-stage selection process, Stéphane Stahl became a member of the American Society for Aesthetic Plastic Surgery (ASAPS), one of the world’s largest and most influential specialist societies for aesthetic surgery. His authorship includes numerous articles in respected peer review journals and standard surgical textbooks.

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