What is the role of surgery in the treatment of digital mucous cysts (DMCs)?

Updated: Jul 31, 2018
  • Author: Murad Alam, MD; Chief Editor: Dirk M Elston, MD  more...
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In a study of about 100 patients, surgery yielded the highest cure rate (95%) compared with sclerotherapy (77%), cryotherapy (72%), corticosteroid injection (61%), and expression of cyst contents (39%) (P<.001).<ref>10</ref>

The most conservative surgical intervention entails multiple episodes of needling the cyst with a wide-bore needle until resolution is achieved. An appropriately trained patient may continue the repeated drainage and scarification required by this method at home. [11]

Another technique is cyst aspiration with a large-bore needle, followed by instillation of corticosteroids (triamcinolone, hydrocortisone, betamethasone) with or without lidocaine. Some practitioners prefer to inject proteolytic agents, such as hyaluronidase, in lieu of steroids, but this may be potentially more risky given the communication of the cyst with the joint. [12]  Corticosteroids may be of benefit in the spectrum of ganglionlike cysts of the digits. [13]

Cryosurgery has been used to treat digital mucous cysts. Carbon dioxide snow, cryoprobes, and the intermittent spray technique have been used. [14]

Sclerotherapy was considered a quick and effective method of treatment. [15] Among the sclerosants infused were Morton fluid, iodine and carbolic acid, sodium morrhuate, ethanolamine, sodium tetradecyl, and polidocanol. Some consider sclerotherapy a dangerous approach because of the potential for extravasation of the chemical into the joint or tendon sheath. However, a 2008 study reported effective treatment of digital mucous cysts with percutaneous sclerotherapy using polidocanol. [16]

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