mucous cyst: operative and non operative treatment

What could be done to eliminate the digital cyst?

A conservativ intervention to eliminate a digital cyst is repeated needling. The mucous cyst is punctured and the cyst content  is squeezed or aspirated. The pucture had to be done with a sterile needle and in a sterile setting.

Three to five punctures are needed for definite resolution of the cyst. In two to three cases a cure rate can be expected.

Some doctors combined the puncture of the digital mucous cyst with a cortison injection of the fingerjoint.

Cortisone injections can offer fast-acting relief of  a painful inflamed fingerjoint. Complications are rare but may include infection of skin and joint.

prognosis of nail deformity:

Can I expect that treatment corrects the nail deformity?

Often – after successful therapy of the digital cyst – the nail deformity improves within 4 – 6 months. But a residual nail deformity may persist. In rare cases deformity can be caused by the operation

operation of a digital cyst:

In which cases should a mucous cyst be operated?

The operational treatment is to recommend by:

  • fail repeated needling,

  • osteophytes (bony surs) into the joint

  • recurrence of the digital cyst

  • complicated cases i.e infection

Which anaesthesia is necessary?

Removal of cyst or bony spurs can usally be performed using regional anaesthesia.

In a cases of simple excision of a mucous cyst, it may be sufficient to numbed only the finger with a local anaesthesia (i.e. lidocain)

numbed a finger

regional anesthesia of a finger

the figure shows regional anesthesia of a finger

Which anaesthesia is in more servere cases necessary ?

Some surgeons prefer a brachial plexus block in severe cases.

What is a brachial plexus block?

There are many techniques for achieving a brachial plexus block. The techniques are classified by the level, at which the needle is inserted  for injection of the local anaesthetic .

brachial blexus

axillary block

The axillary block is widley used: It is suitable for surgery to the forearm, wrist and hand. In this technique a needle is placed in the axilla. (Compare pictures left)

The dorctors should be patient and allow plenty of time for the brachial plexus block to develop ( about 15 – 30 minutes are necessary).

What does the doctor  by the operation of a Fingercyste?

In much case a simple removal of the digital cyst is not sufficient, because this simple procedure is followed by a high recurrence rate. It is better to remove the cyst and the underlying tissue connected to the joint.

A more aggressive surgery remove not only the cyst but also the underlying osteophythes (smal bony spurs) and any stalk connected with the joint.

The picture above shows the removal of a large digital cyst on the thumb. (red arrow). You see no blood becaus the operation is performed in a bloodless field an in an brachial block

For a better understanding an unusual large cyst is presented. Most digital cysts are much smaller!

The digital mucous cyst is carefully dissected from the surrounding tissue. The extensor tendon below the mucous cyst is carefully spared.

In a case of a larger cyst a small flap is used to cover the skin defect. In cases of reccurent cysts or larger skin defects a small skin transplant may be necessary.

Note:

In concluding this informational paper I would like to encourage you to address all questions you may have in connection with a finger cyst (finger ganglion) with your attending physician as this document does not constitute a replacement to a personal examination or consultancy through your doctor.

Mucous Cyst:    1    2    3    4    5

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