A 56-year-old man, with a background of osteoarthritis affecting the thumbs and fingers of both hands, presents with an increasingly painful mass affecting the right middle distal interphalangeal (DIP) joint.
His OA pain has generally been manageable to date with conservative measures, but the pain associated with this mass is not responsive.
He is diagnosed with a digital mucous cyst. He is keen for this to be definitively managed.
What is the most likely diagnosis?
Correct!
Digital mucous cysts affect the dorsal aspects of the DIP joint, typically associated with underlying osteoarthritis. They are most common in the fifth to seventh decade.
A recent systematic review found the five most frequently used treatments are surgical excision, followed by expression of cyst content, sclerotherapy, corticosteroid injection and cryotherapy.
Surgery had the highest cure rate (95%), followed by sclerotherapy (77%), cryotherapy (72%), corticosteroid injection (61%), and expression of cyst contents (39%).
Surgery carries associated risks and potential adverse effects that must be carefully explained.
Sclerotherapy and cryotherapy may require multiple treatment sessions but are less invasive and can be good alternatives for nonsurgical candidates.
Corticosteroid injection and expression of cyst contents are frequently used but have lower cure rates compared to surgery, sclerotherapy, and cryotherapy.
Other less frequently used modalities include CO2 laser vaporisation and infrared coagulation.