Skip to main content
Introduction

A mucous cyst is a benign ganglion that affects the distal interphalangeal (DIP) joint or in the proximal nail fold.  Mucoid cysts are usually small with an average diameter of less than 10 mm. Most (90%) mucoid cysts are associated with the DIP joint osteoarthritis.  Fingernail deformity secondary to the mucoid cyst occurs 25% of theb patients.  Cysts are often asymptomatic and do not require treatment. When they are treated by aspiration, recurrence is common. Surgical recurrence is rare.

Incidence and Related Conditions

  • Ganglia are the most common benign cysts of the hand, accounting for ~70% of all such cysts; mucous cysts comprise 10-15% of this total
  • Mucous cysts usually occur in people aged 50-79 years; women are affected more than twice as often as men

Differential Diagnosis

  • Xanthoma (Giant-cell tendon sheath tumor)
ICD-10 Codes
  • MUCOUS CYST

    Diagnostic Guide Name

    MUCOUS CYST

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    MUCOUS CYST (HAND) M71.342  

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams
Mucous Cyst
  • Mucoid Cyst with deformity of nail because cyst putting pressure of germinal nail matrix.
    Mucoid Cyst with deformity of nail because cyst putting pressure of germinal nail matrix.
  • Mucoid Cyst of thumb with deformity of nail
    Mucoid Cyst of thumb with deformity of nail
  • Mucoid Cyst with OA (Herberden's Nodules)
    Mucoid Cyst with OA (Herberden's Nodules)
  • Mucoid Cyst of Long Finger with deformity of nail
    Mucoid Cyst of Long Finger with deformity of nail
  • Mucoid Cyst left index finger with concave nail deformity.
    Mucoid Cyst left index finger with concave nail deformity.
  • Mucoid Cyst left index finger after spontaneous rupture and drainage
    Mucoid Cyst left index finger after spontaneous rupture and drainage
Symptoms
Lump or mass on dorsal of finger between base of the nail and the DIP joint
Longitudinal Nail deformity (grooves or ridges)
Pain usually mild
History of mass fluctuating in size
History of clear mucinous drainage from the cyst or from the edge of the nail fold
Positive Tests, Exams or Signs
Work-up Options
Images (X-Ray, MRI, etc.)
Mucoid Cyst
  • X-ray finger tip: 1.mucoid cyst;  2.dorsal osteophytes; 3.DIP arthritis
    X-ray finger tip: 1.mucoid cyst; 2.dorsal osteophytes; 3.DIP arthritis
  • X-ray finger tip#2: 1.mucoid cyst;  2.dorsal osteophytes; 3.DIP arthritis
    X-ray finger tip#2: 1.mucoid cyst; 2.dorsal osteophytes; 3.DIP arthritis
Treatment Options
Treatment Goals
  • Eliminate the cyst
Conservative
  • Soaks
  • Local heat
  • Massage
  • topical steroids and Cordran tape
  • Heparin cream
  • Silver nitrate
  • Chemical cauterization with phenol
  • Digital compression, if the cyst is soft and located over a bony prominence
  • Aspiration of the mucinous material
  • Multiple cyst needle punctures with or without steriod injection
Operative
  • "L"-shaped, longitudinal or curved incision; cyst mobilized and excised; osteophytes excised and skin closure.  
  • Dorsal skin flap or full-thickness skin graft is rarely needed.
Treatment Photos and Diagrams
  • Mucoid Cyst with small Herberden's Nodule
    Mucoid Cyst with small Herberden's Nodule
  • Mucoid Cyst excision fifth finger
    Mucoid Cyst excision fifth finger
  • Mucoid Cyst excision right thumb
    Mucoid Cyst excision right thumb
CPT Codes for Treatment Options

Per an agreement between Hand Surgery Resource, LLC and the American Medical Association (AMA) users are required to accept the following End User Point and Click Agreement in order to view CPT content on this website.  Please read and then click "Accept" at the bottom to indicate your acceptance of the agreement.

End User Point and Click Agreement

CPT codes, descriptions and other data only are copyright 2019 American Medical Association (AMA). All rights reserved. CPT is a registered trademark of the AMA. The AMA reserves all rights to approve any license with any Federal agency.

You, as an individual, are authorized to use CPT only as contained in Hand Surgery Resource solely for your own personal information and only within the United States for non-commercial, educational use for the purpose of education relating to the fundamental principles of hand surgery and the common diseases, disorders and injuries affecting the human hand. You agree to take all necessary steps to ensure your compliance with the terms of this agreement.

Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the AMA, CPT Intellectual Property Services, 330 N. Wabash Avenue, Chicago, IL 60611. Applications are available at the AMA Web site, http://www.ama-assn.org/go/cpt.

Common Procedure Name
Excision finger mucoid cyst
CPT Description
Excision of lesion of tendon sheath or capsule hand (cyst or ganglion)
CPT Code Number
26160
CPT Code References

The American Medical Association (AMA) and Hand Surgery Resource, LLC have entered into a royalty free agreement which allows Hand Surgery Resource to provide our users with 75 commonly used hand surgery related CPT Codes for educational promises. For procedures associated with this Diagnostic Guide the CPT Codes are provided above. Reference materials for these codes is provided below. If the CPT Codes for the for the procedures associated with this Diagnostic Guide are not listed, then Hand Surgery Resource recommends using the references below to identify the proper CPT Codes.

CPT QuickRef App.  For Apple devices: App Store. For Android devices: Google Play

CPT 2021 Professional Edition: Spiralbound

Complications
  • Excision may lead to recurrence in small percentage of cases.
  • Stiffness is rarely a functional problem and related to associated DIP josteoarthritis
  • Nail deformity is often associated with mucoid cysts.
  • New nail deformity rarely develops after surgery.2
  • DIP joint infection
  • Post-operative infections can be caused by Mycobacterium chelonae an organism found in tap water.   
Outcomes
  • Aspiration or puncture has a 50% recurrence rate.
  • Excision usually assures satisfactory results
YouTube Video
Mucoid Cyst YouTube Video
Key Educational Points
  • Ganglion cyst on dorsal DIP joint
  • Often associated with osteoarthritis and osteophytes in the area of tdhe cyst or stalk
  • Osteophyte excision improves surgical outcomes 
  • The terminal extensor tendon's insertion must protect carefully during surgery.
  • Associated nail deformity common
  • Cysts communicate with the DIP joint
  • Spontaneous drainage can be associated with infection
References

New Articles

  1. Johnson SM, Treon K, Thomas S, Cox QG. A reliable surgical treatment for digital mucous cysts. J Hand Surg Eur 2014;39(8):856-60. PMID: 24162456
  2. Jager T, Vogels J, Dautel G. The Zitelli design for bilobed flap applied on skin defects after digital mucous cyst excision. A review of 9 cases. Tech Hand Up Extrem Surg 2012;16(3):124-6. PMID: 22913990
  3. Patel MR, Malaviya GN.  Chronic Infections.  In Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH (eds).   Green’s Operative Hand Surgery 6th ed.  Philadelphia, PA: Elsevier, 2011: 118-127.

Reviews

  1. Li K, Barankin B. Digital mucous cysts.J Cutan Med Surg 2010;14(5):199-206. PMID: 20868616
  2. Rizzo M, Beckenbaugh RD. Treatment of mucinous cysts of the finger: Review of 134 cases with minimum 2 year follow-up evaluation. J hand Surg Am 2003; 28A: 519-524.
Subscribe to MUCOUS CYST