What is the probable cause of a recurring cystic swelling on a patient’s finger and how would it best be managed – conservative treatment, cryotherapy or surgical intervention?
A 66-year-old male office worker presents with a swollen, inflamed cuticle that discharges clear fluid following application of pressure (Figure 1). He had noticed a cystic swelling on the dorsum of his left middle finger over the distal interphalangeal joint (DIPJ) eight weeks earlier, which spontaneously drained, leaving a residual nail defect. Relevant past history includes a DIPJ fracture many years ago, with secondary osteoarthritis (OA) and osteophyte formation. He is treated conservatively.
On follow up three months later, he reveals that he has had two other attacks, with progressive nail changes (Figure 2).