Mucous Cysts

What is a Mucous Cyst?

Mucous cysts are a type of ganglion. They originate from the distal interphalangeal (closest to the tip of the finger) joints of fingers.
They are filled with joint fluid that condenses over time and forms a gel.
They form because joint fluid escapes through a small gap in the joint capsule into the cyst
Mucous are not dangerous or cancerous. They are usually very unlikely to cause permanent harm if left untreated.

What is it?

What causes it?

How does it present?

Immobilisation with brace/splint to help reduce size of ganglion and relieve discomfort, it does not necessarily ‘cure’ a cyst.
Aspiration draining the fluid out of the cyst with a needle can help alleviate pain and reduce the size temporarily, but will not prevent the ganglion from reforming.
Use of an anti inflammatory, for discomfort caused by a ganglion.

What can be done?

If there is constant pain or discomfort
If the cyst ruptures repeatedly.
If the cyst
- Stop you doing the 'things you have to do' and/or
- The 'things you love to do' in life
If you would prefer a definitive cure for the problem.
If appearance is unacceptable

When is surgery needed?

This surgery is usually done under local anaesthetic
The anaesthetist commonly gives some sedation (a twilight anaesthetic)
It is done as a day case in a hospital
- but you cannot drive home after the procedure
- and you should not be home alone on the night of your surgery

How does surger work?

A skin incision is made directly over the cyst
The cyst is removed including the sac and an area of joint capsule where the ganglion originates.
The wound is closed. A dressing and bandage are applied.

What do we do in surgery?

In Hospital

A bandage is applied to the hand.
It is important that the hand remains elevated ‘higher than your heart’ to help limit swelling
If the bandage feels too tight, do not hesitate to remove it.
It is usual to leave hospital 2-3 hrs after surgery

At Home

Continue to elevate your arm until swelling in your fingers subside.
Move your fingers (making a full fist and straightening your fingers out fully about 10-20 times a day).
Keep the wound dry covered and clean.
If it is not uncomfortable, leave the bandage in place until your first appointment after surgery
Blood thinning medication (if you are on any) can be started 2 days after surgery
An appointment usually arranged with my practice nurse at about 1-2 weeks after surgery.

After the surgery

The wound usually heals over 1-2 weeks and any sutures are then removed
Self care (washing, dressing, eating) with the operated hand – usually around 5 days
Driving: when you are able to control a steering wheel with your operated hand and you are not taking strong pain relief anymore (usually 5-10 days post surgery)
Most moderate activities (equivalent to lifting a pot of the stove or pouring a full kettle) can usually be achieved by 4-6 weeks,
It can take 3-6 months for stiffness and deep scarring in the site of the operation to resolve.
Golf, fishing, cycling etc.: usually around 6-12 weeks, but it can be longer (3 months)

The recovery

Infection
Stiffness of the joint (wrist/finger). You will be given some exercises to do at home, but may need hand therapy.
It very occasionally happens that the tendon that straightens the joint fails due to the surgery, and it may can result in the tip of the finger drooping.
It is common to have a bit of numbness next to the scar. Sometimes the scar can be very sensitive for a long time
Recurrence, the excision may be unsuccessful and need to be done again.
Very rarely (around one in a thousand)a severe pain reaction , (CRPS) can develop, which can be disabling for years.
An anaesthetic can have complications, such as nausea, heart and lung problems. Please discuss it with your anaesthetist before the operation.

What can go wrong?

What can you expect?

Full recovery is usually expected.