Surgery Spotlight: Ganglion of the Distal Interphalangeal Joint Surgery-Surgery Spotlight: Ganglion of the Distal Interphalangeal Joint Surgery

Surgery Spotlight: Ganglion of the Distal Interphalangeal Joint Surgery

Video Transcription

Hi, I'm Mike Neumeister from Southern Illinois University School of Medicine. This case is about a distal interphalangeal joint ganglion.  The patient presents with tenderness on palpation and has pain on movement of the joint.  So as you can see, she's got this DIP ganglion, it's a cyst, it's rather large, it's positioned directly over the DIP joint.  This bump that you see right there, this is actually the osteophyte that's coming from the joint itself. So the key component to this operation is actually resecting this.  It is not resecting this, simply decompressing the cyst is all we need to do. With the main part, remove that osteophyte.  The incision is transformed to what we used to do as a T-type of incision to get at more access.  It's evolved to a straight line incision in the lateral border, again, only to get directly at the osteophyte, remove that, and then you can simply decompress that.  So we do this under a local anesthetic. The patient has had some sedation already.  We'll exsanguinate the finger or the thumb.  Just the knife there, we actually don't need that part. So incision, this goes straight down to the joint itself.  The incision, the blade is now turned in this direction to go on top of the collateral ligaments. This will help gain access to the cyst itself.  This is the cystic gelatinous fluid. You can see it actually coming from the cyst itself.  Now we'll raise up a small portion of the joint capsule.  And I'll take a retractor from it, or a skin hook. You have a double hook there.  And do you have a 15 blade from me again?  How about a rag now from it?  And I'll take the ronger now. Let's go this direction. Do you have the scissors? So this bony prominence may be somewhat difficult to see. But there's the joint itself.  Here's the joint.  It's opened up right there. Significant osteophyte on this side of the joint. And another osteophyte on this side of the joint. Joint space. Osteophyte on this side of the joint.  And an osteophyte on this side of the joint. So the key element to this is to take the ronger and to debride those osteophytes.  So this actually smooths out this part of the joint. And now the cyst itself, we don't have to remove the entire cyst, but we simply decompress it. There's the gelatinous fluid.  As you can see, how thin this skin is here, if we remove the entire cyst wall, you may compromise this skin and result in exposed tendon.  And so by removing the osteophyte, decompressing the cyst, the problem is resolved. Now do you have a 5-0 chromic stitch?  There's no need to repair the collateral ligament as there's just a straight line incision and its entire insertion and origin have not been removed. So it should go on to heal.  Do you have the scissors here? Yeah, a 2-inch would be better.  Okay, actually remove those guys. Here's the key point about dressings.  I do like to actually wrap it around the wrist and then come back around the digit itself, whether it's on the finger or the thumb. Do you have scissors?  So that the dressing won't fall off when they're sleeping. And that's the treatment of a DIP ganglion.  As you can see from this case, a small 1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-1-  1-1-

Video Summary

Dr. Mike Neumeister from Southern Illinois University School of Medicine describes a surgical procedure for treating a distal interphalangeal joint (DIP) ganglion. The patient has pain and tenderness due to a large cyst and associated osteophyte. The operation involves making a straight incision to access and remove the osteophytes, then decompressing the cyst without removing its entire wall to prevent compromising the skin. The procedure uses local anesthesia and does not require repairing collateral ligaments. Proper dressing, wrapped around the wrist and finger or thumb, is essential to ensure stability during recovery.

Asset Caption

Michael W. Neumeister, MD demonstrates surgery on a patient with a distal interphalangeal joint ganglion who presents with tenderness on palpation and has pain in movement of the joint.

Surgeon Michael W. Neumeister, MD

This product is not certified for CME.

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Michael W. Neumeister MD; Memben

DIP ganglion

surgical procedure

osteophyte removal

local anesthesia

Dr. Mike Neumeister