Treatment of Distal Interphalangeal Ganglion Cysts by Volar Corticosteroid Injection

Abstract

Background: Various options exist for operative and nonoperative treatment of symptomatic distal interphalangeal (DIP) ganglion cysts. We describe the technique and efficacy of a novel treatment of DIP ganglion cysts using a volar, transtendon, intra-articular injection of corticosteroid.

Methods: This was a single center, retrospective study (2010-2015) of 21 patients who received a volar, intra-articular corticosteroid injection for treatment of DIP ganglion cysts. The patients were contacted via mailing with a short survey. For those potential study participants who did not respond to the mailing or were not seen in follow-up, contact was made via telephone. The primary study outcome was resolution of the cyst; secondary outcomes included pain and postinjection complications.

Results: A total of 21 patients (14 female; 7 male) with 23 DIP ganglion cysts were treated in this study. The dominant hand was involved in 56.5% cases. Twelve (52.2%) resolved or had near complete resolution following injection at an average follow-up of 20 months.

Conclusions: For patients with DIP ganglion cysts, this newly described technique of volar, transtendon, intra-articular injection of corticosteroid provides a safe and effective treatment. This technique allows for ease and consistency of needle placement for intra-articular corticosteroid delivery while minimizing the potential soft tissue and infection concerns described with other techniques.

Keywords: DIP ganglion cyst; corticosteroid injection; digital mucous cyst; distal interphalangeal joint.

Figure 1.

Radiograph identifying the location of the distal flexion creases in relation to the distal interphalangeal joint.

Figure 2.

To inject into the distal interphalangeal joint, the needle must be angled distally from the flexion crease: (a) clinical photograph; (b) radiographic image.

Figure 3.

Hypopigmentation following intra-articular injection of the distal interphalangeal joint from a volar approach. Note. In this patient, triamcinolone acetate was utilized. Since this patient, the senior author has utilized dexamethasone for this injection, including all patients in the currently reported series. No further hypopigmentation has been encountered since this change.