Lumps and bumps on the wrist and hand are very common, with the vast majority being benign and of no serious consequence. They may occur at any age, yet their incidence increases in the elderly. They may vary from a very common callus, which arises in the skin from repetitive pressure causing skin thickening, to rare and serious tumours.
The most common lump by far is a ganglion. These account for more than 50 per cent of such lumps. This is simply a collection of jelly-like fluid in a sac which may arise from an irritated joint in the wrist or hand, or from an irritated tendon.
These lumps most commonly occur on the back of the wrist (dorsal wrist ganglion), front of the wrist near the base of the thumb (volar wrist ganglion) as well as in the palm (seed ganglion) and near the fingernail bases (mucoid cyst).
Ganglion lumps may follow injuries or be a consequence of wear and tear in the joint or tendons or even due to repetitive stress. They may increase in size slowly or fluctuate in size and may cause pain by causing pressure on surrounding tissues.
This category of lumps may be left alone; however, if they cause pain or stiffness with wrist or hand use, their surgical removal would be required. Historically, these ganglia were drained in clinic with a syringe, but this has a very high recurrence rate.
The second most common lump on the hand and wrist region is the osteophyte. These are the lumps that give the fingers a knobbly appearance in arthritis. These are bony projections that develop from joints as they wear away. They are most commonly found at the tips of the fingers around the most peripheral joints and are called Heberden’s nodes. When they are present around the middle joints of the fingers, they are called Bouchard’s nodes.
These osteophytes may also be found on the back of the wrist and are called carpal bosses. Unless painful, these lumps don’t need addressing.
Another commonly seen lump is the inclusion cyst. These are benign growths caused by an injury to a hand or finger, often developing years after the injury. They are caused when a penetrating wound, such as a deep cut, pushes surface cells into the deep layers of the hand or finger. These cells are encapsulated and gradually expand in size over time. These may need excision if bothersome, and often, this can be done under local anaesthetic.
Other less common causes of lumps in the palm of the hand include gouty tophi. Gout is a condition in which there is inflammation or swelling of the joints due to increased levels of uric acid in the blood. This uric acid gets accumulated in the affected joints. These inflamed joints can appear like a lump in the hand.
Other lumps include dupuytrens contracture. This is a condition in which there is the formation of thick tissue which extends from the hand into the finger. Due to this, the finger into which the tissue extends appears to be contracted or appears to be bent towards the hand. It is painful for some people.
Malignant tumours of the wrist and hand do exist but they are very rare and must not be missed. Some examples of such cancerous lumps are malignant melanoma of the skin and squamous cell carcinoma. These must be surgically removed at an early stage. Giant cell tumours are not maligant but locally aggressive and arise from the covering of the tendons.
Alistrair Pace is a consultant orthopaedic surgeon.