What ist a mucous cyst?

Mucoid cysts are bulges of the finger and thumb end joints at the beginning of wear of the finger end joint. The cysts are filled with gelatinous yellowish liquid. Mucoid cysts impress as cherry pit-sized, hard tumors shimmering through the skin. They are most frequently located on the extension side of the finger end joints. The middle finger, index finger and thumb of the guiding hand are most frequently affected. Mucoid cysts occur in 75% of cases in women, mostly between the ages of forty and seventy. There is always a connection to the finger joint. The liquid content consists mainly of hyaluronic acid which is produced by fibroblasts. Mucoid cysts are also referred to in the literature as pseudocysts or dorsal cysts. Pressure and shear forces in the end joint are assumed to be the cause for the development of mucoid cysts. Mucoid cysts often occur with bony attachments at the end joints, the so-called lifting nodules. An aesthetic impairment due to swelling and disturbance of the nail growth are usually the reason for a visit to the doctor. Pain or movement restrictions occur less frequently. In about thirty percent of patients, the nail deforms. The deformation of the nail usually disappears after an operation. If there is a painful restriction in the movement of the finger end joint, the 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.

The removal of mucoid cysts of the finger end joint prevents spontaneous opening and enables the correction of nail deformation. Accidental opening of the dorsal salt cyst, for example during gardening work, is associated with a high risk of inflammation. Inflammation of an injured mucoid cyst can lead to severe joint inflammation. The operation can maintain mobility. The risk of a dorsal salt cyst returning after an operation is low.

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?

  • All your questions about possible complications and alternative treatments should be answered before surgery.
  • Keep nicotine and alcohol consumption to a minimum.
  • Blood-thinning medication (e.g. ASS, Thomapyrin®) must be discontinued at least ten days before the operation after consultation with your doctor.
  • 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.
  • Surgery limits the ability to travel by air. Therefore, do not plan any professional or private air travel during 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 third postoperative week onwards, several daily circular massages for a few minutes, along and across the course of the scar with oily creams (e.g. Bepanthen® ointment or Linola® fat) help to create inconspicuous scars.
  • The skin threads are removed after ten to fourteen days.

Author's statement

Author: Stéphane Stahl, MD, PhD. There are no financial relationships with the pharmaceutical or medical device industries that could have influenced the above text. Any reproduction, even partial, is permitted for personal use only. All texts used on this website are protected by copyright.

 

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