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Mucous Cyst

Distal interphalangeal joint (DIPJ) ganglion, commonly called a mucous cyst, or Dorsal digital ganglion cysts

Distal Interphalangeal joint ganglion commonly present as lumps on the dorsum of the finger at one or other side of the joint. They can also form at the edge of the proximal nail fold. They are harmless and will frequently resolve on their own.  

Mucous Cyst figure 1
images courtesy of NHS Lothian
Mucous Cyst figure 2
images courtesy of NHS Lothian

They tend to occur in older people and are usually associated with underlying joint degeneration (osteoarthritis of DIP joint).  

  • The lump can fluctuant in size.  
  • If they grow at the proximal nail fold, they can cause a nail deformity (groove or nail split) due to pressure on the germinal matrix. 
  • They can be painful, but it can be difficult to tell if the pain is coming from the lump or the underlying osteoarthritis. 
  • The mucous cysts can burst. The skin overlying can be thin and translucent. These factors can allow infection to develop and track deep into the joint. 
  • We do not recommend aspiration or bursting of mucous cysts, as this can lead to septic arthritis. 

Surgical excision may be indicated for mucous cysts with thin skin or history of bursting, or those that cause a nail deformity. 

Please see the patient information sheet opens a new window(see primary care management tab) and print off and give to the patient. 

It is usually best to leave the cyst alone unless it is causing significant symptoms. Any treatment of the cyst carries a risk that may leave the patient worse off. 

Who to refer:

  • Mucous cysts that have burst recurrently and are at risk of developing deep infection (septic arthritis) 
  • Mucous cysts causing significant symptoms in patient who have tried first line treatment options, and are willing to take the risks associated with surgery (see PRIMARY CARE MANAGEMENT SECTION)
  • Please include a photograph of the patients lump 

Who not to refer:

Patients who have not undergone first line treatment with minor or cosmetic symptoms (see PRIMARY CARE MANAGEMENT SECTION)

Direct referral to the hand service 

Please include a photograph of the patient’s cyst/lump  

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