Mucous Cyst 727.41

 

mucous cyst

synonyms:mucoid cysts, synovial cysts, myxoid cysts, myxomatous cutaneous cysts

Mucous Cyst ICD-9

  • 727.41 Ganglion of joint
  • 715.14 Loc prim osteoarthritis; hand
  • 883.1 Open wound of finger, complicated (883.1)

Mucous Cyst Etiology / Epidemiology / Natural History

  • Usually 5th-7thdecade
  • Female > male
  • Most are associated with DIP joint arthritis and may have a pedicle from the DIP joint.

Mucous Cyst Anatomy

Mucous Cyst Clinical Evaluation

  • Fluid filled cyst and thin skin over the DIP joint of a finger.
  • May have chronic drainage or infection
  • The cyst itself, or the underlying arthritis in the DIP joint may be painful.  
  • May cause longitudinal grooving of the nail due to pressure on nail matrix

Mucous Cyst Xray / Diagnositc Tests

  • AP and lateral views of the affected digit: generally demonstrate DIP arthritis with dorsal osteophyte.

Mucous Cyst Classification / Treatment

  • Mucous Cyst excision as well as osteophytes.  Avoid injury to extensor tendon, nail matrix, articular surface, often requires rotation flap or full thickness skin graft for closure.
  • CPT: 26160 Excision of lesion of tendon sheath or capsule; cyst, mucous cyst, or ganglion, hand or finger
  • Post-op care=cast or splint for 2wks if skin graft used.  Early motion otherwise

Mucous Cyst Associated Injuries / Differential Diagnosis

  • epidermoid inclusion cyst
  • Heberden nodes
  • rheumatoid nodules
  • xanthoma
  • giant cell tumor of the tendon sheath
  • gout.

Mucous Cyst Complications

  • Extensor tendon rupture / lag
  • Recurrence
  • Incomplete relief of pain
  • Nonuion
  • Infection
  • Painful hardware
  • Nail deformity
  • Stiffness

Mucous Cyst Follow-up Care

  • Post-op: place in extension splint, STAXX splint if extensor tendon repair required or skin graft used.   Early motion otherwise
  • 7-10 Days: wound check.  Staxx splint if extensor tendon repair, early ROM otherwise.

Review References

  • Thornburg LE. Ganglions of the hand and wrist. JAAOS. 1999;7:231-8. 
  • Budoff JE. Mucous Cysts. J Hand Surg Am 2010;35:828
  • Kasdan ML, Stallings SP, Leis VM. Outcome of surgically treated mucous cysts of the hand. J Hand Surg Am 1994;19:504.
  • Shin EK, Jupiter JB. Flap advancement coverage after excision of large mucous cysts. Tech Hand Up Extrem Surg. 2007;11:159.
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