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This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

• Scientific data regarding mucous cysts consist almost entirely of retrospective studies [1].
• Much of the management or recommendations for mucous cysts is based on expert opinion [1].
• Total dorsal capsulectomy alone is a simple treatment for mucous cysts that does not lead to any recurrence [2].
• Excision of the cyst combined with complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence [3].
• Osteophyte excision without cyst excision may be a good treatment choice for mucous cysts of the finger, providing a less invasive method with complete resolution in most cases [5].
• Osteophyte removal results in a low cyst recurrence rate, indicating it should be undertaken regardless of the surgeon's plan for the soft tissues [13].
• The Zitelli bilobed flap allows excision of the cyst and thinned skin with no added risk to the nail matrix [6].
• The use of a Wolfe graft for mucous cysts is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates [7].
• Surgical excision with a local advancement skin flap is a reliable treatment for digital mucous cysts, demonstrating a low recurrence rate of 1.4% and high patient satisfaction regarding the scar and willingness to undergo the procedure again [9].
• A surgical technique involving excision of the cyst, synovectomy, and débridement of osteophytes with rotational flap closure resulted in no recurrences in thirty-six patients [10].
• Pathohistological analysis is useful in cases where doubts arise about the initial diagnosis of a benign tumorous lesion [4].
• Eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal [8].

Anatomy & Pathophysiology

• Mucous cysts are associated with marginal osteophytes at the distal interphalangeal joint [3].
• The primary pathology in mucous cysts involves osteophytes, and removal of these osteophytes allows for skin recovery potential [20].
• Ultrasound is a powerful modality for evaluating pathologic conditions in the hand and wrist [16].
• Ultrasound provides a cost-effective and expedient alternative or adjunct to MRI for hand and wrist evaluation [16].
• Ultrasound is best used when there is a specific clinical question regarding a well-localized abnormality [16].
• Subungual keratoacanthoma may show locally aggressive behaviour but does not metastasize [14].

Classification

• Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger, providing a less invasive method with complete resolution in most cases [5].
• The use of a Wolfe graft is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates [7].
• There is a statistically significant difference in recurrence rates between Type I giant cell tumours of the tendon sheath (0%) and Type II tumours (38%) [11].
• Recurrence in Type II giant cell tumours of the tendon sheath is likely due to undetected satellite lesions or incomplete excision [11].
• Incomplete excision of a granular cell nerve tumor can lead to recurrence [12].
• Osteophyte removal results in a low cyst recurrence rate [13].
• Osteophyte removal should be undertaken regardless of the surgeon's plan for the soft tissues [13].

Clinical Presentation

• Malignant natural-killer cell neoplasms can present as a mucous cyst on the distal interphalangeal joint of the finger [4].
• Eccrine porocarcinomas can present as a hand cyst [8].
• Subungual keratoacanthoma may present as a condition masquerading as flexor tenosynovitis in the finger [14].
• Ultrasound is a powerful modality for the evaluation of pathologic conditions in the hand and wrist [16].
• Ultrasound provides a cost-effective and expedient alternative and/or adjunct to MRI for hand and wrist evaluation [16].
• Ultrasound is best used when there is a specific clinical question regarding a well-localized abnormality in the hand or wrist [16].

Investigations

• Much of the management of mucous cysts is based on expert opinion [1].
• Pathohistological analysis is useful when doubts arise about the initial diagnosis of a benign tumorous lesion [4].
• Ultrasound is a powerful modality for evaluation of pathologic conditions in the hand and wrist [16].
• Ultrasound provides a cost-effective and expedient alternative and/or adjunct to MRI [16].

Treatment

• Scientific data regarding mucous cysts consist almost entirely of retrospective studies, and much of what is done or recommended is based on expert opinion [1].
• Excision of the cyst and complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence [3].
• Osteophyte removal results in a low cyst recurrence rate, indicating that it should be undertaken regardless of the surgeon's plan for the soft tissues [13].
• Use of Wolfe graft is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates [7].

Complications

• Scientific data regarding mucous cysts consist almost entirely of retrospective studies, with many recommendations based on expert opinion [1].
• Total dorsal capsulectomy alone for mucous cysts did not lead to any recurrence [2].
• Osteophyte excision without cyst excision may provide complete resolution in most cases [5].
• Use of a Wolfe graft provides satisfactory cosmesis with acceptable recurrence rates [7].
• Surgical excision with a local advancement skin flap demonstrates a low recurrence rate of 1.4% and high patient satisfaction regarding the scar [9].
• Incomplete excision can lead to recurrence of granular cell nerve tumors [12].
• Type II giant cell tumors of the tendon sheath have a 38% recurrence rate, likely due to undetected satellite lesions or incomplete excision [11].
• Malignant natural-killer cell neoplasms can present as mucous cysts on the distal interphalangeal joint [4].

Recovery

• Much of the treatment for mucous cysts is based on expert opinion [1].
• Incomplete excision can lead to recurrence in granular cell nerve tumors [12].

Key Evidence

• [L4] The scientific data regarding mucous cysts consist almost entirely of retrospective studies, and much of what is done or recommended is based on expert opinion. [1] (10.1016/j.jhsa.2010.01.029)
• [L4] A total dorsal capsulectomy alone was a simple treatment for mucous cysts and did not lead to any recurrence. [2] (10.1016/j.jhsa.2014.03.004)
• [L4] Excision of the cyst and complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence. [3] (10.2106/00004623-197355030-00013)
• [L5] This case emphasizes the utility of a pathohistological analysis in cases where doubts arise about the initial diagnosis of a benign tumorous lesion. [4] (10.1007/s00402-008-0794-4)
• [L4] Osteophyte excision without cyst excision may be a good treatment choice for mucous cyst of the finger, providing a less invasive method with complete resolution in most cases. [5] (10.1177/1753193413478549)
• [L4] It allows excision of the cyst and thinned skin with no added risk to the nail matrix. [6] (10.1016/j.jhsa.2017.03.013)
• [L4] The technique is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates. [7] (10.1177/1753193408103498)
• [L4] Prompt recognition and appropriate treatment are critical because eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal. [8] (10.1016/j.jhsa.2016.07.112)
• [L4] Surgical excision with a local advancement skin flap is a reliable treatment for digital mucous cysts, demonstrating a low recurrence rate of 1.4% and high patient satisfaction regarding the scar and willingness to undergo the procedure again. [9] (10.1177/1753193413508540)
• [L4] A new surgical technique involving excision of the cyst, synovectomy, and débridement of osteophytes with rotational flap closure resulted in no recurrences in thirty-six patients. [10] (10.2106/00004623-197254070-00008)
• [L3] The study found a statistically significant difference in recurrence rates between Type I tumours (0%) and Type II tumours (38%), with recurrence in Type II likely due to undetected satellite lesions or incomplete excision. [11] (10.1054/jhsb.2000.0522)
• [Case_report] The author notes that while the true recurrence rate is unknown, incomplete excision can lead to recurrence. [12] (10.1016/j.jhsa.2009.05.011)
• [Commentary] The article shows that osteophyte removal results in a low cyst recurrence rate, indicating that it should be undertaken regardless of the surgeon's plan for the soft tissues. [13] (10.1177/1753193413510663)
• [L4] Subungual keratoacanthoma may show locally aggressive behaviour but does not metastasize. [14] (10.1177/1753193409360605)
• [L5] Ultrasound is a powerful modality for evaluation of pathologic conditions in the hand and wrist, providing a cost-effective and expedient alternative and/or adjunct to MRI, best used when there is a specific clinical question regarding a well-localized abnormality. [16] (10.1016/j.jhsa.2009.02.010)
• [L5] The authors of the original study believe that extensive damage to the skin is unnecessary and that the skin has recovery potential once the main problem (osteophytes) is removed, favoring a less invasive approach over techniques requiring skin flaps. [20] (10.1177/1753193414546443)

References

[1] Mucous Cysts. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.01.029

[2] Total Dorsal Capsulectomy for the Treatment of Mucous Cysts. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.03.004

[3] Marginal Osteophyte Excision in Treatment of Mucous Cysts. The Journal of Bone & Joint Surgery. 1973. DOI: 10.2106/00004623-197355030-00013

[4] Malignant Natural-Killer cell neoplasm presenting as a mucous cyst on the distal interphalangeal joint of the finger. Archives of Orthopaedic and Trauma Surgery. 2008. DOI: 10.1007/s00402-008-0794-4

[5] Osteophyte excision without cyst excision for a mucous cyst of the finger. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413478549

[6] The Zitelli Bilobed Flap on Skin Coverage After Mucous Cyst Excision: A Retrospective Cohort of 33 Cases. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.03.013

[7] Use of Wolfe Graft for the Treatment of Mucous Cysts. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193408103498

[8] Eccrine Porocarcinoma Presenting as a Hand Cyst. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.07.112

[9] A reliable surgical treatment for digital mucous cysts. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413508540

[10] Etiology and Treatment of the So-Called Mucous Cyst of the Finger. The Journal of Bone & Joint Surgery. 1972. DOI: 10.2106/00004623-197254070-00008

[11] Giant Cell Tumours of Tendon Sheath: Classification and Recurrence Rate. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2000.0522

[12] Granular Cell Nerve Tumor in the Hand: Case Report. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.05.011

[13] Commentary on Lee et al. Osteophyte excision without cyst excision for a mucous cyst of the finger. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193413510663

[14] Metastases to the finger masquerading as flexor tenosynovitis. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193409360605

[16] Ultrasound of the Hand and Wrist. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.02.010

[20] Re: Lee HJ, Kim PT, Jeon IH, et al. Osteophyte excision without cyst excision for a mucous cyst of the finger. J Hand Surg Eur. 2014, 39: 258–61. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414546443