Mucous cyst excision is an operation to remove a ganglion-like cyst arising from the distal interphalangeal (DIP) joint. These cysts are associated with underlying osteoarthritis and may cause nail deformity or skin thinning with risk of spontaneous rupture.
An incision is made over the cyst on the back of the fingertip. The cyst is excised along with its stalk connecting it to the DIP joint. The underlying osteophyte (bone spur) is usually removed to reduce recurrence. If the skin is thinned, a local rotation flap may be needed. The operation takes 20–30 minutes.
Surgery is recommended for cysts that are enlarging, causing nail deformity, at risk of rupture through thinned skin (which would introduce infection into the joint), recurrent after aspiration, or causing pain.
Observation, aspiration (high recurrence rate), and compression. Many cysts are asymptomatic and can be left alone.
X-ray showing DIP joint arthritis and osteophyte. Day-case procedure.
Removal of the cyst and prevention of recurrence. Nail deformity typically improves over six to twelve months as the nail grows out.
May persist if the germinal matrix has been damaged.
Over the fingertip.
Some DIP joint stiffness.
Approximately 5–10% if the osteophyte is not removed.
If the skin was very thin.
Wound or joint infection.
From osteophyte removal.
Digital nerve block.
Light dressing for two weeks. Stitches at 10–14 days. Gentle finger movement immediately. Full recovery four to six weeks. Nail regrowth takes four to six months.
Wound check at two weeks.
If the nail matrix (root) has not been permanently damaged by the cyst, the nail usually improves as it grows out over four to six months.