Ganglion Cyst - Fingers

What is it?

Ganglion cysts are frequently located on the top or bottom of the wrist. Another common location; however, is the joints of the finger near the fingernail (distal anterior phalangeal joint). The cyst at this location usually occurs between the ages of fifty to seventy. It is associated with a local area of osteoarthritis (Heberden's nodes). The exact cause of these ganglion cysts is unknown, although it is certainly associated strongly with localized osteoarthritis. These cysts are not cancerous and do not become cancerous.

What are the symptoms?

The cyst usually presents with either pain or soreness, a deformity of the nail, or a visible small mass on the top of the finger just proximal (before) to the nail.

How is it evaluated?

The diagnosis of a ganglion cyst at the DIP joint (mucous cyst) is usually easy on physical examination and history. X-rays are frequently ordered to identify the extent of the localized osteoarthritis. This will aid the surgeon in preoperative planning and discussing the need for more extensive operations.

How is it treated?

Nonoperative

  1. The cyst, since it is not dangerous to the patient, can be treated with observation only. Frequently, however, the cyst remains bothersome to the patient with pain, soreness, a deformity of the nail bed, and it may spontaneously rupture leaking a small amount of gelatinous material. Infection is a known, but relatively infrequent complication of these cysts.
  2. Aspiration of these cysts is not recommended. It is extremely unlikely to resolve the problem and may result in further infection.

Operative

Surgical excision, the surgical treatment of the cyst is usually an outpatient procedure performed under local anesthesia. The finger is anesthetized with an injection at the palm level.

An incision is made on the top of the finger that includes the cyst and may extend down to the middle part of the finger. The extensor tendon is identified and protected. The cyst is identified and removed. The area of localized osteoarthritis at the joint is completely removed. This markedly decreases the chances of recurrence.

Post operative Care

The finger is placed in a protective dressing that may or may not include a protective splint. This dressing is left in place for approximately one to two weeks. The sutures are removed usually at approximately two weeks.

Will the cyst recur?

With removal of the cyst and removal of the osteophyte (area of localized arthritis), the chances of recurrence of are unlikely.

Will the deformity in the nail improve?

Usually, with removal of the cyst and relief of the pressure on the germinal matrix (the part of the nail that produces the nail) of the nail, will improve in its appearance. This usually requires at least four to eight months.