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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

• 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].
• 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].
• Pathohistological analysis is useful in cases where doubts arise about the initial diagnosis of a benign tumorous lesion [4].
• Subungual keratoacanthoma may show locally aggressive behaviour but does not metastasize [14].

Classification

• 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].
• Pathohistological analysis is useful in cases where doubts arise about the initial diagnosis of a benign tumorous lesion [4].
• 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 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 is simple, easy to perform, and provides satisfactory cosmesis with acceptable recurrence rates [7].
• Eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal [8].
• 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].
• 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

• 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].
• 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

• Scientific data regarding mucous cysts consist almost entirely of retrospective studies [1].
• 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].
• Eccrine porocarcinomas have a substantial risk of metastasis, high risk of local recurrence, and are potentially fatal [8].
• 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].
• Ultrasound is best used when there is a specific clinical question regarding a well-localized abnormality [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].
• Total dorsal capsulectomy alone is a simple treatment for mucous cysts that does not lead to any recurrence [2].
• Excision of the cyst and 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 cyst 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 that 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].
• Use of Wolfe graft 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].

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].
• Excision of the cyst and complete removal of the marginal osteophyte eradicates mucous cysts with extremely rare recurrence [3].
• Osteophyte excision without cyst excision may provide complete resolution in most cases [5].
• The Zitelli bilobed flap allows excision of the cyst and thinned skin with no added risk to the nail matrix [6].
• 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].
• 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].
• 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].
• 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].

Recovery

• Scientific data regarding mucous cysts consist almost entirely of retrospective studies [1].
• Much of the treatment 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 and 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].
• 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 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].
• 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].
• 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