Signs and Symptoms
- Noticeable bump on the back (dorsum) of the hand close to the wrist
- May or may not be associated with pain
Diagnosis
- History and physical exam will help determine both diagnosis and treatment
- X-rays will confirm diagnosis
Background
A carpometacarpal boss is a bony lump or bump that occurs over the back of the wrist. It presents similarly to a ganglion cyst. It is not inherently dangerous. It can be painless, or it can be uncomfortable and restrict wrist motion. Treatment course depends on the individual situation, presentation, and potential functional limitations that may exist. Conservative treatment is possible for many people provided the boss is not irritating or uncomfortable at all. Surgical removal is typically recommended if the mass is chronically painful, bothersome, or limiting movement or function. The general post-op hand therapy course is outlined below.
Treatment
Conservative (Non Surgical)
This may provide temporary relief of discomfort and not change the bony prominence
- Splinting
- Corticosteroid injection
Surgery
For those with chronic discomfort or limited motion or function
Hand Therapy
Week 1-2:
- 1 week after surgery, the bulky dressing will be removed. Compressive gloves, fingersocks, or dressings may be applied for swelling management. As soon as is feasible, various active and passive exercises will be provided to you by your therapist.
- Sutures will be removed 10-14 days after surgery. When sutures are removed, manual techniques will be initiated to control scar formation and swelling.
- A custom splint may be made for you to protect the incision and minimize post-op discomfort. You should wear this at all times when not completing your home exercises.
- Keep your hand elevated about the level of your heart when possible to minimize swelling.
- Toward the end of this period, gentle stretching may begin if your wrist range of motion is limited. This will be added to your home program.
Week 3-4:
- Progressive strengthening will begin around this time. Splint wear can be gradually decreased and discontinued. Your therapist will continue to use scar management techniques, and may use other modalities such as therapeutic ultrasound to facilitate healing and to help soft tissue rebound faster. Wrist stretches will typically continue during this time as well.
Week 5-6:
- Strengthening and exercises will have been upgraded considerably by this time. Your grip strength should be approaching pre-operative range. You will most likely be discharged from therapy around this time, to continue independently with your home program. You can typically use the hand normally in daily activities. Ask your doctor if you intend to return to sports or strenuous work or other hand-intensive activities.
