Mucous cysts / Osteoarthritis

Mucous cysts / Osteoarthritis

What is it?

Osteoarthritis (OA) in the hand is very common in the general population. The cause of osteoarthritis is not clear, but genetics are important. With multiple joint disease, OA tends to affect the knuckle at the tip of each finger. It starts by causing general discomfort, then the joint becomes inflamed and deformed. The deformities can consist of lumps, stiffness or an altered shape of the joint. See image below.

In the early stage, soft swellings can appear at the base of each nail. This is often a mucous cyst (or ganglion). They can occasionally be tender or have pressure effects on the nail (causing an indentation). Sometimes these cysts burst spontaneously. Other time they are persistent. If they cause trouble, it may be useful having a surgical consultation. Options at this point are aspiration or excision. (A small operation, usually under local anaesthetic, where the lump is removed.)

Do I always need an operation?

In the majority of patients, with OA, the pain settles and the finger joint stiffens up. However if the pain remains or the joint becomes difficult to use, because of the deformity, surgery may be required.

If the cyst on my finger requires to be removed what would surgery involve?

The operation is usually a day case procedure, which means you, can arrive and leave on the same day. It is usually performed with local anaesthetic, which means only part of your hand goes numb. Afterwards a large dressing is applied, which you can reduce at 72 hours. You need to keep the initial dressing dry. We will usually see you back in the clinic at around 10 days for removal of the stitches. The next appointment would be around 6 weeks. You will usually be able drive once the large dressing has been removed, IF, you are not restricted and have minimal pain. You must be able to perform all manoeuvres safely within the car.

Are there any risks?

With any wound there is a risk of infection, but the relative risk is approximately 1%. Initially the scar can be tender. Daily desensitisation, massage and moisturising is important. The cyst itself can affect the growth of the nail. So can the surgery, but this is usually temporary. There is a risk of recurrence of the cyst unfortunately.

If the osteoarthritis in my finger is very painful are there any non-operative treatments?

Splints and regular analgesics or anti-inflammatory medications can help. Occasionally a steroid injection is useful.

If these non-operative treatments fail what are the surgical options?

For these joints, fusion is the best option. Fusion will only restrict the movement at the tip, but it is probable that movement before the operation is very poor anyway. It takes the pain away and allows grip to improve.

If fusion is required what does that entail?

The operation is usually a day case procedure, which means you, can arrive and leave on the same day. It is usually performed with local anaesthetic, which means only your finger goes numb. Usually two wires are used to stabilise the joint while it is healing.

Afterwards a large dressing is applied, which you can reduce at 72 hours. You need to keep the initial dressing dry. The hand therapist usually provides a small splint for the first couple of months. We will usually see you back in the clinic at around 10 days for removal of the stitches. The next appointment would be around 6 weeks.

The wires are removed in the clinic at 6 weeks (which is usually without pain.)

You will usually be able drive once the large dressing has been removed, IF, you are not restricted and have minimal pain. You must be able to perform all manoeuvres safely within the car.

Are there any risks?

With any wound there is a risk of infection, but the relative risk is approximately 1%. As there will be a couple of wires through the skin, the infection risk is slightly higher. Any redness or discharge should be looked for. If there is excessive pain please phone the department. Otherwise the other risks are of non-union, where the bone fails to heal and scar tenderness.