Lumps and Bumps of the Hands and Wrists

From Benign Cysts to Rare Cancers of Bone and Soft Tissue

Rheumatoid arthritis, general practitioner examining patient and hand for signs of rheumatoid arthri
ADAM GAULT/SPL / Getty Images

Many things can cause the formation of lumps and bumps on the hands and wrists. In some cases, the masses may visible and physically aggravating. In others, they may not be felt or noticed at all. The causes of these growths are diverse, ranging from benign cysts to rare cancers of the bone, cartilage, and soft tissue.

Diagnosis can often be made with a physical examination of the mass as well as imaging studies, such as an X-ray or MRI, when needed.

A definitive diagnosis may require an evaluation of tissue samples by a pathologist, either obtained by a biopsy or surgical removal of the mass.

5  Most Common Hand of Wrist Masses

When diagnosing a hand or wrist mass, a doctor will typically explore the most common causes first, usually noncancerous growths, cysts, and tumor. The most common causes include:

  • Ganglion cysts are considered the most likely suspect, representing about 50 percent of all abnormal hand and wrist growths. Ganglion cysts are caused when the lining of the small joints forms a small pouch into which fluids leach and accumulate. Cysts can also form pouches in the sheath covering a tendon or knuckle joint, which we refer to as a mucous cyst.
  • Giant cell tumor of tendon sheath is not a true tumor but rather a mass which arises from the lining of a tendon (sheath) or a joint (synovium). Giant cell tumors of tendon sheath tend to grow slowly and can often become extremely painful. The problem with these masses is that they are easily removed but often come back.
  • Inclusion cysts are benign growths caused by an injury to a hand or finger, often developing years after the injury. Inclusion cysts are caused when a penetrating wound, such as a deep cut, pushes surface cells into the deep layers of the hand or finger. Thes cells, considered foreign, are encapsulated by the immune system and gradually expand in size over time.
  • Carpal boss is the overgrowth of bone on the back of the hand similar in appearance to a bone spur. It is essentially a small area of osteoarthritis occurring at the junction of the long hand bones and small wrist bones. While frequently misdiagnosed as a ganglion cyst, a carpal boss is invariably firmer and fixed in its position. Unlike a cyst, you cannot move it or feel any "give" when you press on it. 
  • Enchondroma is a noncancerous tumor which develops when cartilage grows inside a bone. An enchondroma can become a problem if and when the tumor weakens the bone, increasing the risk of a pathologic fracture. Enchondromas are mostly benign with only around one percent developing into cancer.

Cancer of the Hands or Wrists

While cancer seldom originates in the hands or wrists, there are rare cases of where tumors have formed in the bone or cartilage of the hand. These cancers are called sarcomas and represent less than one percent of all solid tumor malignancies in adults. By contrast, one in five children with cancer will have a sarcoma. They predominantly develop in soft tissue (such as fat and muscle), although around 10 percent will occur in the bones of the hands or wrists.

It is not entirely clear what causes sarcoma.

Family history and exposure to chemicals or radiation are known to play a part.

When cancer develops beneath the skin of the hand or wrist, it is most often due to a malignancy that has spread (metastasized) from a tumor in another part of the body, most often the lungs.

Source:

Teh, J. "Ultrasound of soft tissue masses of the hand." J Ultrason. 2012; 12(51): 381-401.

Continue Reading