What is a digital mucous cyst?
The digital mucous cyst is a ganglion cyst that arises from the end finger knuckle (the distal interphalangeal joint) or nail matrix and appears on the back of the fingertip 1.
The origin of the term digital mucous cyst: from Greek digitus = finger; mucous refers to a thick substance in the cyst; cyst = enclosed pouch.
Synonyms
- Mucinous cyst
- Digital mucoid cyst
- Periarticular fibroma
- Periungual ganglion
- Myxoid cyst
- Nail cyst
- Cystic nodule
- Reference: 1
Causes and Pathology
Mucous cysts most commonly occur in 40-70 years old individuals with osteoarthritis, more frequently in women 1. They can appear at any age but are rare in children 1.
Trauma may be a cause in some cases 2.
Digital mucous cysts are not hereditary; they are not caused by infection, do not spread, they are benign (they do not invade nearby tissues) and do not develop into skin cancer 6.
Some cysts arise from the distal finger knuckle due to degeneration of the tissues in the joint, but others seem not to be related with the joint and develop due to abnormal growth of the connective tissue cells (fibroblasts) under the skin 5.
Cysts are filled with a clear, thick jelly-like substance 6.
Symptoms and Signs
- A small, 1-10 mm or, rarely, bigger, firm, rubbery papule or lump on the upper (dorsal) side of the fingertip on any finger, mostly index or middle finger of the predominant hand or, rarely, on any toe may appear suddenly or over several months. A cyst can be partially translucent or bluish. Some cysts look like warts.
- One or more cysts on one fingertip or more fingertips can be present.
- The overlying skin can be thinned and partly translucent, or moderately thick and flesh-colored or rough as a wart.
- A cyst may appear under the nail, which can be depressed or have longitudinal grooves and red or blue lunula (a thin, normally pale, proximal part of the nail). Nail grooves may precede the cyst for as much as six months.
- A cyst can be tender to touch.
- Usually, only larger cysts are painful.
- Decreased range of motion in the last finger joint
- A cyst can spontaneously burst or disappear.
- References: 1,2,5
Pictures
Picture 1. A wart-like mucous cyst on the middle finger
(source: Eatonhand)
Picture 2. A mucous cyst on the finger. The skin over the cyst is thinned.
(source: Eatonhand)
Picture 3. A mucous cyst on the thumb. The skin over the cyst looks thinned.
(source: Eatonhand)
Picture 4. Mucous cysts on both thumbs
(source: Eatonhand)
Picture 5: A mucous cyst behind the nail, which is deformed.
(source: Eatonhand)
Diagnosis
- A doctor can usually make a diagnosis from observation and palpation of the cyst.
- Transillumination reveals a translucent cyst.
- An X-ray may show bone spurs (osteophytes) in the distal interphalangeal joint, which are usually associated with osteoarthritis.
- Ultrasound, CT and MRI can all clearly show the cyst.
- Injection of methylene blue dye into the cyst 12 hours prior the surgery can reveal the extent and origin of the cyst during the surgery.
- References: 1,2,3
Picture 6. Transillumination of a mucous cyst.
A cyst is translucent, so light shines through it.
Note a longitudinal groove in the nail.
(source: Eatonhand)
Differential Diagnosis
The digital mucous cyst may look like:
- Xanthomas – yellowish bumps in individuals with increased triglyceride levels.
- Warts
- Bone spurs
- Herpetic whitlow
- Molluscum contagiosum
- References: 1,8
Treatment
Possible treatments:
- Heat: soaking in warm water or applying warm compresses
- Ointments: corticosteroids, such as triamcinolone acetonide (complication: skin thinning or local depigmentation), heparin cream, silver nitrate
- Massage or compression with fingers
- Repeated puncture with a needle and draining may be effective in 70% cases (Video 2) 5
- Aspiration with a large-bore needle followed by an injection of steroids is not very effective (high rate of recurrence) 5
- Cryosurgery with carbon dioxide snow or cryoprobes (freeze-thaw-freeze method, ~30 seconds) is effective (up to 15% recurrence) 5.
- Sclerotherapy with an injection of polidocanol or Sodium tetradecyl sulfate 10 (complication: a sclerosant can leak into the joint). The treatment has a low recurrence rate 10.
- Chemical cauterization with phenol
- Curettage with or without electrodesiccation
- Carbon dioxide laser vaporization 7
- Infrared contact coagulation
- Cold-steel surgical excision with possible graft reconstruction has a high rate of recurrence 5.
- Surgical removal of a bone spur (osteophyte) with or without cyst removal. Possible complications include fingertip deviation, persistent swelling, stiffness, pain, numbness, impaired mobility, nail deformities, tendon damage, skin or joint infection. Some doctors believe wearing a finger splint for 2-10 days after the procedure can reduce discomfort 5.
- References: 4,5
NOTE: Striking a mucous cyst with a book is not recommended because of the possibility of a finger injury.
Video 2. Digital cyst drainage
Treatment Complications
- Stiffness or limited motion in the distal interphalangeal joint 9
- Treatment of a cyst under the nail can result in a permanent nail deformity 9.
Recurrence
Recurrence of a mucous cyst is common and typically occurs within 3 months of treatment 1. Surgical removal of the cyst and bone spurs has the lowest recurrence rate 4,5.
- References
- Emedicine (Digital mucous cysts)
- Emedicine (Symptoms and signs)
- Emedicine (Diagnosis)
- Emedicine (Treatment)
- Aafp.org (Office management)
- The Australian College of Dermatologists (Digital mucous cyst)
- PubMed (Carbon dioxide laser vaporization)
- PMC (Case: 88-year old man with a mucous cyst)
- PMC (Treatment options)
- Pubmed (Sclerotherapy)
I had a large mucus cyst on my thumb in the knuckle joint. It was pretty large and I was pressing on it and it popped inside my thumb. So now I’m wondering, Did I make it worse or is it coming back? I have a small one on my other knuckle. It was so weird to feel it pop.
I have 3 of what I believe to be these cysts on my index finger. I am wondering i f it’s because I have used that finger to type for many years..I don’t type the traditional way. The cysts are small no pain and the skin around them is thin. I picked at the smallest one and it bled and I was excited to see it was gone. Well a month later it was back. I have had theem for a year now. Will they go away?
Has anyone tryed the freezing technique?
I had one and opted for surgery, unbelievable the cost… day surgery $9500. – Surgeon $4200. After 3 weeks it has come back. homeopathic now!
Hi..I’ve just started with these.. ..what homeopathic can I use please …
Hi- did you figure out any home techniques to get rid of it?
I want to say thank you to everyone. I thought I had a piece of glass in my finger but now i know im going to try the oils and see how it goes.
I had an infection like the video shows. I poked it with a needle and 2 days later thick transparent geel like pus came out. I made sure I drained it completely for 2 to 3 days and soaked it twice a day in salt water for about 2 days. So far it looks good and I hope it will not come back.
I have what appears to be a cyst on my left index finger (at the DIP, but on the side of the finger, just below the joint). I tried to drain it with a needle, only blood came out. It bled for 20 minutes at a slow rate (one drop of blood every 3 to 5 seconds). I tried to drain it again two days later and got similar results. It looks like a cyst with a red head on it. Is this the way a Mucous Cyst should react?
No…mucous cyst contains clear or yellowish fluid. I recommend you to visit a dermatologist and not to try to drain the cyst on your own.
Sounds like yours may be a pyogenic granuloma.
Not all ganglion cysts drain. I have one on my finger tip and it didn’t and one on my toe and it did
Prior to coming to this site, tonight I took a needle, ran it through what I thought was an inflamed blister. I knew it wasn’t an ordinary type but thought what the heck. When the jell substance came out, well, that was a surprise. Lol thanks to Google, key words blister jell like substance and here I am.
Thank you to whomever took the time to share the ABC of this mucus cyst
My mucoid cyst was near the bed of my nail and was very painful; the doctor recommended surgery which I declined; she then gave me some kind of ointment to apply which did nothing. A friend of mine who is very knowledgeable about essential oils suggested rubbing frankincense on it. I did that daily for several days and after about 3-4 days it was completely gone. No wonder it was a gift of the magi–it is truly miraculous.
Be certain you obtain good quality oil.
I have a small bump directly beneath my nail bed. It is painful.
thanks!
Pat, I came to this site and hope you’re doing well. I was recently diagnosed with a digital mucus cyst on my finger, near the bed of my nail, struggling with it over two months already. The dermatologist recommended surgery, but I’m reluctant to do it. So I would like to try your friend’s recommendation by rubbing frankincense on it, purchased in Walgreens. Hopefully it’ll work for me as well. Can you please tell me if you diluted the oil, or just used it straight?
Your input is greatly appreciated.
When mine swells and hurts I squeeze out what I can then put tea tree and lavender essetional oils on it wrapped it with gauze then I drop oils down into bandage throughout the day after few days it’s flat again takes longer to appear but not as large and doesn’t hurt right now
what kind of Doctor do I go for this ?
Deborah, probably to an orthopedist.
I do have a digital mucous cyst on the middle finger of my left hand at the base of the nail bed, with distortion of the nail growth. The cyst seems to come to a head and I have personally popped the ”head” with a needle and pressed the thick clear liquid out on three occasions. This relieves pressure and discomfort. The cyst only become sore to the touch when enlarged. Removing the gel like liquid definitely gives relief. Can I continue with this procedure without having surgery?
Sheila, doing it by yourself increases the risk of infection. A small surgery may definitely resolve the problem.
I have one that appeared summer 2015, Last Christmas it felt tender .Went to the doctor and he removed it and left a hole in my finger and sever pain and I could not use the hand for at least 2 weeks ,had antibiotics oral and topical.Took over 6 weeks to heal
Came back I popped it a few times I used the balance of the anti antibiotic cream. It went away for at least 3 months then came back this september .I popped it and drained it using rubbing alcohol as an antiseptic for the needle ( very very fine) and the cyst also. It came back and i popped it about 3 more times more (an average of ever 1 and half week when it looked like it was full) it has gone down now for over a week and no pain and does not look like it is filling up. Fingers crossed .No more surgery for me
I had a ganglion on my hand years ago and a naturopath made a mix of essential oils that worked for one that her father had. I used it and it went completely away. I would really like to find out what the oils were. If anyone knows…please help!
Hello Bev,
Can you share who the “naturopath” was? Did he/she supply the mix of essential oils or gave you the prescription to get the oil from somewhere? If a prescription, where did you get it?
Also, did you have a small opening on the tissue at the bottom of the clear cyst?
Thanks for sharing!
I have a ganglion cyst under the nail on my index finger which has become very painful. There is no nail deformity. I was told the only way to remove the cyst would require the nail to be removed. Is there a method that does not involve removing the nail.
Harriet, the nail will probably need to be removed, but maybe not the entire one. And the nail should then grow back normally.
Thank you!!. Have had this cyst for a year. Primary Dr. didn’t know what it was-wart? -sent me to Dermotologist. Dermotologist didn’t know what it is. I’m tired of incompetent doctors.
How long does it take the tenderness from bone spur surgery (digital cyst) in middle finger
to go away? I had procedure done three months ago and it still feels tender
Niela, I can’t reliably answer this. The surgeon should know better.
Jan, what is your medical background & do you currently practice medicine? If so, what country do you practice in & where are you originally from? Thanks!
Gayle, I have finished a medical faculty at University of Ljubljana in Slovenia and I live here. I currently work as a health researcher and writer not as a doctor.
can cortisone rubbed on the cyst make it disappear? is there any medicine you can suggest to make cyst disappear? I do not want surgery. but the nail has a vertical indentation it it. Thanks
Eleanor, cortisone cream may help, but I can’t say if it will help in your case. You should not apply the cream for more than 2 weeks in a row because it may permanently thin your skin.
I had surgery to remove 2 of these cysts. Shortly after surgery, 3 days, I developed an infection. Surgery was done 10/2/15, took 3 weeks for the wounds to close. It’s now been 3 months and my surgery seems to have removed the cysts, but my fingers are now disfigured and hurt more than before the surgery. I’ve been back to see my Dr. 5 times. He won’t look me in the eye and told me at 2 months out things would be better and they are not. What should I do? I wish I never had the surgery, the pain and discomfort now outweighs the previous condition, but my Dr. is just telling me to wait.
Lisa, if possible, get a second opinion as soon as your condition is still relatively fresh. A new doctor can then tell, what can be done.
I have been just referred to the surgeon to remove mine, which is on the outer part of my thumb, right on the joint. The pain is horrible and my poor thumb is always swollen; reading at your post just made me realize how much u want to abound any kind of complications. I guess I will continue suffering with my little bundle of liquid pain.
You can ask the doctor if he/she will remove the cyst *completely,* which means the liquid and the membrane should go out completely and what are the chances for the cyst to be cured completely.
I hand. Surgery on a moucous cyst in May, it came back two weeks later. I went back to the Dr. two month later and he gave me a shot is the cyst. Well two months late it was really big and sore so I went back to the Dr. This time he drained it a gave me a shot in that finger but my nail is growing in sunken. Is that normal.
Cherly, I can’t judge if your current nail appearance should be considered normal or not, so you may want to ask the doctor.
I have one of these cysts where the nail has a groove… it was poked by a dermatologist and it bled..she put some antibiotic stuff on it and covered it.. thing is it keeps filling up with that gooey stuff, goes flat, and fills again…so wondering if it should be removed so it won’t come back? I’m like Judy… I keep knocking it and hurts like the dickens…
Ann, not only poking, but a complete removal of the cyst would prevent its recurring. You can discuss this option with your doctor.
Very common, I am having mine removed with minor surgery in two weeks. Worked with it for 6 months , extruding contents etc. tired of it, go to competent hand surgeon, remove it . End it. Good luck. ?
I had a cyst removes from finger 12 days ago. I have repeatedly bumped it causing it to turn purple. Today it burst open (Sunday) and it appeared that the tendon or inside of my finger was poking out. I pushed it back in but it ia very sore, inflamed and open weeping wound. Should i go back to my dermatologist tomorrow or schedule an appt with a hand surgeon? Not certain what to do but will soak in diluted peroxide water. Any suggestions?
Judy, yes, you should go back to a doctor who can close the wound as soon as possible to avoid severe infection.
Correction to Jan Modric’s comment of November 13th, a staph infection is not just ‘an infection of a hair follicle’. Staphylococcus aureus is a bacteria that many of us have living on our skin. It can cause a problem if there is an open wound or sinus (hole entry leading to deeper tissues). It would need to be diagnosed by swab, where microbiology culture and grow any discharge or a wound bed swab. There any many bacteria that can colonise a wound. If there is no open wound, bacterial infection is unlikely. I have these finger cysts which may have inflammation around them but are closed, so not infected with staph or any other type of bacteria.
Jonathan, I did not say a staph infection is “just” an infection of a hair follicle. I mentioned that because Mary said he had a “wart with a hole in it.” Mucous cysts do not have openings but infected hair follicles have. Warts also can have what looks like an opening on the top.
Can a doctor actually remove one with a major scar?
Joanne, the scar would be thin–about 1 mm–and short–about 1 cm.
I have a mucous cyst which created grooves on my nail, and the cyst ruptured but than it filled up again the Doctor wants to remove my whole nail, (nailbed included) is this necessary for just a cyst. I was scheduled for surgery and I bailed out because I feel that the removal of my nail is not necessary.
Jane, this is quite specialistic question. I suggest you ask another doctor for second opinion.
I was told I had a digital mucous cyst on my index finger. It’s been there about 6 months, recently it seemed to get larger. It looked translucent, but when the doctor lanced it and expressed the contents by pressing the sides with her finger it was not clear gel, the substance squirted out, and it was thick and the color of pus. On day three after the procedure, it is slightly raised and still sore.
Should I expect a reoccurrence of another digital mucous cyst, if so what is the recommended follow-up treatment?
Charlotte, I can’t say was it a mucous cyst or a small furuncle ( a staph infection) and I can’t say will it recur. If it will, go to the doctor again.
I originally thought that what I had was a spider bite. After 2 weeks of just a lump looking like a wart with a hole in it, the sore started to swell and fill with pus. It stayed like that for two weeks and then turned black. I went to the ER and was told that it was a staph infection. After a week of antibiotics, it ruptured. I went to see my own doctor and he said that it was a synovial cyst and it had ruptured. I would need to have surgery to remove it. How serious is this surgery? I have been dealing with this for a month. Am I in danger of loosing a finger because I waited so long? And the pain is almost unbearable.
Mary, you don’t lose fingers from a minor infection or cyst, like you described. A staph infection is an infection of a hair follicle, so it typically has an opening. Mucous cyst does not have an opening. So, maybe you had a small cyst and the infection occurred nearby. In any case, a doctor needs to firmly confirm what was it: an infection, a cyst or both. From what you’ve described it sounds like a staph infection, but I can’t exclude a cyst. If it turns out you have a cyst and if you have a surgery for it, discuss with a doctor to remove it *completely* – a surgeon should know what does this mean. An incompletely removed mucous cyst can recur.
Mary, the best thing to do is talk to your doctor and get the proper information you require to make an informed decision. Don’t pay attention to social media remedies or advices, except mine of course.
I went to my doctor to drain my mucous cyst and he drain the jelly in it.But I notice that the cyst is like getting fill up .Is their a home remedie I can do at home to help remove the cyst?.
reynaldo, remedies and other treatment possibilities are described above in the article.
I have a middle finger mucus syst which is paining me more after I pop it it fill up again and again can I get it lanced as I went to the Drs and was prescribed an antibiotic but it’s not an infection it’s a syst how and where can I get this removed Tewkesbury
Rachel, if you want to get removed a mucous cyst for good, a surgeon needs to remove it.
I had my digital mucus cyst removed by a doctor. He said that it would probably return. It did return. I just drain it at home, treat with antibiotic cream and then cover with a water proof bandaid. The longer I kept it covered and moist the better it felt. After having this cyst for 2 years, it has finally flattened and is gone. Just a small scar and the finger pain is gone. I have another one on my other hand right at the nail bed. This one never looked like a wart like the other one did. Never any pain with this one, just fluid under the skin. Amazing that I pressed it in and it’s like the fluid absorbed into the skin and it is now flat as well. I really don’t know why. Can’t tell you how happy I am that they are gone.
thank you for sharing your info because I am in the same situation but it is very difficult to know when it is going to blow up again and explode. A constant worry of getting an infections especially since I am a nurse, but I so do not want to go through surgery again and have to take off 6weeks of work again. I will try your remedy and be hopeful. What antibiotic did you use?