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Intraarticular injection of the interphalangeal joint for therapy of digital mucoid cysts

  • Observational Research
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Abstract

Mucoid cysts are associated with osteoarthritis (OA) of the digital joints and frequently recur after needle drainage, injection, or surgical ablation. This study determined whether intraarticular injection of the adjacent interphalangeal joint rather than the cyst itself might be effective in resolving digital mucoid cysts. Using paired case series design and sterile technique, 25 consecutive OA digital joints with an adjacent mucoid cyst underwent dorsal non-transtendinous intraarticular injection with a 25-gauge needle and 20-mg triamcinolone acetonide, followed by puncture and manual expression of cyst fluid. Patient pain was measured with the 10-cm Visual Analogue Pain Scale prior to the procedure and at 6 months. Cyst resolution was determined at 6 months and 3 years. The subjects were 61.0 ± 7.7 years old and 60% (15/25) female. Mucoid cysts were adjacent to 19 distal interphalangeal, 3 metacarpophalangeal, and 3 interphalangeal joints. Pre-procedural pain was 4.7 ± 1.0; procedural pain was 6.2 ± 0.6 cm, and post-procedural pain at 6 months was 1.2 ± 0.8 cm (74.5% reduction, 95% CI of difference: 3.0 < 3.5 < 4.0 (p < 0.0001)). 84% (21/25) of the cysts resolved at 6 months; however, 60% (15/25) of the mucoid cysts recurred within 3 years and required retreatment (14 adjacent joints re-injected and 1 ablative cyst surgery). No complications were noted. Intraarticular corticosteroid injection using a dorsal non-transtendinous approach of the joint adjacent to a mucoid cyst is effective resolving cysts and reducing pain at 6 months; however, 60% of mucoid cysts reoccur within 3 years and may require reinjection or surgery.

Trial registration: This was not a clinical trial.

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Acknowledgements

The authors thank Ms. Jackie Cremar for technical assistance in preparation of this article. There were no conflicts of interest of any of the authors in this study. There was no outside support for this research.

Funding

There was no internal or external support for this study.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Rheumatology and School of Medicine, University of New Mexico Health Sciences Center, MSC 10 5550, 5th FL ACC, Albuquerque, NM, 87131, USA

    Rosemina A. Patel, Angie Ariza-Hutchinson, N. Suzanne Emil, Maheswari Muruganandam, Sharon E. Nunez, Matthew K. McElwee, Frank X. O’Sullivan & Wilmer L. Sibbitt Jr.

  2. Department of Exercise and Sport Sciences, New Mexico Highlands University, Las Vegas, NM, USA

    William A. Hayward

  3. Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia

    Luke J. Haseler

Authors
  1. Rosemina A. Patel
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  2. Angie Ariza-Hutchinson
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  3. N. Suzanne Emil
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  4. Maheswari Muruganandam
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  5. Sharon E. Nunez
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  6. Matthew K. McElwee
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  7. Frank X. O’Sullivan
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  8. William A. Hayward
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  9. Luke J. Haseler
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  10. Wilmer L. Sibbitt Jr.
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Contributions

The authors declare that they have followed the ICMJE criteria on authorship, have given explicit consent to submit, approve of the version to be published, and have obtained consent from the responsible authorities. RAP—Procedures, manuscript composition and revision. AA-H—Procedures, manuscript composition and revision. NSE—Manuscript composition and revision. MM—Procedures, manuscript composition and revision. SEN—Manuscript composition and revision. MKM—Manuscript composition and revision. FXO—Manuscript composition and revision. WAH—Manuscript composition and revision. LJH—Manuscript composition and revision. WLS Jr.—Procedures, data collection, photographs, ultrasound, manuscript composition and revision.

Corresponding author

Correspondence to Wilmer L. Sibbitt Jr..

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Conflict of interest

The authors Patel, Ariza-Hutchinson, Emil, Muruganandam, Nunez, McElwee, O’Sullivan, Hayward, Haseler, and Sibbitt declare no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Data sharing statement

Raw data are included in tabular form in the article and can be obtained from the authors on request.

Ethics approval

This study was approved (Study 20-662k, Submission ID: CR00007815, Approval End Date 10/26/2022) by Institutional Review Board (IRB)—the Human Research Review Committee of the University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA and all patients provided written consent to all examinations and procedures. All studies were carried out in accordance with the World Medical Association Declaration of Helsinki (JBJS 79A:1089-98, 1997). Patient confidentiality was protected according to the U.S. Health Insurance Portability and Accountability Act (HIPAA) and all data were de-identified.

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Patel, R.A., Ariza-Hutchinson, A., Emil, N.S. et al. Intraarticular injection of the interphalangeal joint for therapy of digital mucoid cysts. Rheumatol Int 42, 861–868 (2022). https://doi.org/10.1007/s00296-021-05082-0

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  • DOI: https://doi.org/10.1007/s00296-021-05082-0

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