Mucous pseudocyst (Figure 9.53) can be caused by systemic conditions that affect joints and in particular the distal joint (see p. 178). This tumour can produce pressure on the nail matrix resulting in a longitudinal nail groove. When the second toe is longer than the other toes, it may cause increased pressure on the toe from the shoes, especially in tennis players. Treatment usually consists of removal of the cyst and overlying skin and debridement of the arthritic distal interphalangeal joint. Magnetic resonance imaging (MRI) demonstrates the relationship of the cyst to the other soft tissue structures of the toe (Figure 9.54).
Myxoid cyst associated with distal interphalangeal joint osteoarthritis.
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