I see many patients with different types of lumps and bumps of the hand and wrist. The vast majority of hand and wrist tumors are benign (non-cancerous), but they should all be evaluated by an orthopedic hand specialist. Any abnormal mass or growth is considered to be a “tumor”. These can occur on the skin, like a mole or a wart, or can be underneath the skin in the soft tissue, the fat layer, the muscle, or even the bone. There are many different types of tissues in the hand and wrist, so many types of tumors can occur.
What are the most common hand and wrist masses?
Ganglion cysts – These are the most common type of mass that represents around 50% of all hand and wrist growths. A ganglion cyst occurs when the tough lining of the small joint forms a pouch where joint fluid collects resulting in a “ballooning-out” of the lining of the tendon sheath or joint. This fluid is very thick, with a molasses-like consistency and when it fills the cyst, it makes it feel very firm. These cysts can also form as pouches off a knuckle joint or tendon sheath and are often referred to as mucous cysts. The treatment options I offer for these include aspiration, where the mass is punctured and the fluid is removed with a needle, or removal by means of surgery.
Giant Cell Tumor of the Tendon Sheath – Giant cell tumors are not true tumors as much as they are firm masses, and they are the second most common types of hand and wrist masses. These masses develop from joint lining known as synovium or from a tendon sheath. Giant cell tumors grow slowly and are quite painful. I can usually easily remove these lesions, but they often come back. Though these growths sound bad but they are slow growing and benign.
Epidermal Inclusion Cysts – I see these masses after an injury to the hand or finger and they often show up years later. An inclusion cyst develops just underneath the skin and is often quite firm. When an injury such as a deep cut occurs, the surface cells are pushed into the deep layers of the palm or finger resulting in the formation of a cyst in the area of injury. Skin cells produce a protective, way substance called keratin and when skin cells get trapped under the surface, they will continue to grow and make this keratin, which forms the cyst.
Carpal Boss – This common type of mass isn’t a tumor, but rather is an overgrowth of bone on the back of the hand. Carpal bosses are similar to bone spurs and often are often misdiagnosed as ganglion cysts. This type of mass is firmer and not movable, however. Occasionally the bump of a carpal boss is problematic, I might recommend removal of the symptomatic bone spur.
Enchodroma – When the cartilage grows inside the bone, an enchodroma occurs. These masses are non-cancerous but can present a problem when the bone becomes weakened and can lead to a fracture from weak bone. Usually I can fix the fracture while bone grafting the lesion to treat the lesion. Again, these are usually benign.
Lipomas, Neuromas, and Fibromas – These masses are all usually benign growths. Lipomas are fatty tumors, neuromas are nerve tumors, and fibromas are tumors of the fibrous connective tissue material of the hand and wrist. They can occur on the hand and wrist regions and are usually benign but often symptomatic. Many patients request removal of these lesions which not only treats the lesion, but provides a firm diagnosis.
Should I worry about cancer?
Though uncommon, the most common kinds of cancer that affects the hand and wrist include squamous cell carcinoma, basal cell carcinoma, and melanoma. While cancer seldom originates in the hand and wrist region, there are rare cases of bone and cartilage tumors that could result. When cancer originates in the hand, it is called sarcoma and is due to abnormal growth of the bone, cartilage, or soft tissues. While sarcomas are rare, it is always best to come to my office for an evaluation if you have a concerning mass of the hand or wrist.
What will an orthopedic specialist do for a lump or bump of the hand or wrist?
First of all, I will perform a careful history and physical examination to help determine the type of hand or wrist tumor you have. Often, x-Rays may be necessary to evaluate the bones, joints, and soft tissues. Further diagnostic studies, such as CT, MRI, or Bone Scan, might narrow down the diagnosis. Treatment will depend on the type of mass you have. Generally, definitive treatment with the lowest recurrence rate involves the surgical removal of the mass. This will allow me to send the tissue off to a pathologist to analyze it and determine what exact type of growth you have.
In general, I recommend evaluation of all hand masses to establish a firm diagnosis and a reasonable treatment plan. Most tumors are benign, but can often be symptomatic. Usually excision of the lesion is curative and can help provide a reassuring diagnosis.