Blind Curettage Technique for Treatment of Mucous Cysts Associated with Heberden Nodes: Description of Operative Technique

Abstract

The standard treatment for mucous cysts with Heberden nodes is excision of the dorsolateral osteophytes and capsule of the distal interphalangeal joint or thumb interphalangeal joint, including the stalk of the cyst. The skin incision varies for cases depending upon the geometry. We propose a surgical method utilizing blind lateral approaches for treating such mucous cysts.

Keywords: Heberden nodes; capsulectomy; cystectomy; mucous cysts; osteophytectomy.

Fig. 1

Clinical (A) and radiological (B) pictures of an eccentrically located cyst. (B) Radiographs showing ipsilateral osteoarthritis (yellow circle) in the distal interphalangeal joint. The clinical picture of the bilateral cyst (C) and radiological (D) findings of osteoarthritis in the distal interphalangeal joint.

Fig. 2

Hemilateral technique. (A) Clinical picture of a dorsoradial mucous cyst in the left thumb. (B) A small skin incision less than 5 mm is made on the dorsoradial side. (C) The picture shows the drainage of jelly-like liquid with collapsing cyst after blind curettage of the dorsolateral osteophytes and capsule between the terminal tendon and collateral ligament with a small sharp curette. (D) The saline is injected through an elastic intravenous cannula into the joint space to reinflate the collapsed cyst. (E) The cyst wall is collapsed by pressing. (G) The intraoperative picture at the end of the procedure. (H) No recurrence after a year.

Fig. 3

Bilateral technique. (A) Clinical picture of a central cyst on the dorsal interphalangeal joint of the left thumb. (B) Through a small incision on the ulnar side, jelly-like liquid is drained by collapsing the cyst following a blind curettage. Similarly, we make a radial side incision (C, D). The effective curettage is confirmed when irrigated saline comes out from the radial side after ballooning the collapsed cyst.

Fig. 4

Application of hemilateral technique for the eccentric cyst. (A, B) A large oval-shaped eccentric cyst in an oblique direction on the dorsal interphalangeal joint of the left index digit. (C) There is no need to modify the blind curettage technique for different sizes and shapes of cysts. A hemilateral small incision will effectively do osteophyte removal and capsulectomy without cystectomy. (D) The patient had no recurrence at 18 months follow-up.