|
Year |
2007 |
|---|---|
|
Question Number |
50 |
|
Category |
Hand |
Question
A 63-year-old woman has a mass over the dorsal aspect of her distal phalanx. She denies any history of trauma, but she reports occasional discomfort. Examination reveals a well preserved range of motion. The mass appears to be stretching the skin. A clinical photograph is shown in Figure 16. Treatment should consist of
l- observation.
2- liquid nitrogen application.
3- aspiration.
4- distal interphalangeal joint arthrodesis.
5- excision of the cyst and underlying bone spur.
Figures
Answer (click for answer)
The answer is 5- excision of the cyst and underlying bone spur.
The image shows a mucosal cyst of the digit. These are small fluid filled sacs that usually develop in 50-70 yr olds, woman more than men. They are associated with DIP arthritis in 75% of cases. Typical location is between the DIP and the nail; it is basically a ganglion of the DIP joint. There are frequently associated osteophytes. Treatment includes excising the cyst widely, removing osteophytes, joint lavage, and skin graft or rotational flap if necessary.
Observation can be reasonable with asymptomatic cysts, but rupture of the cyst causes fistulization of the joint which can lead to infection. Aspiration has less than a 50% success rate.
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