Carpal Boss

What is a carpal boss?

A carpal boss is a bony lump or overgrowth on the back of your wrist. It occurs where your pointer finger and middle finger meet your wrist bones. The lump is firm, doesn’t move and usually doesn’t hurt. Other names for a carpal boss include carpometacarpal boss or carpal bossing.

Carpal bossing is sometimes confused with other health conditions like a ganglion cyst. Your healthcare provider may recommend you come in to rule out other conditions. But a carpal boss doesn’t require treatment unless you’re in pain or experiencing other symptoms.

What are the symptoms of a carpal boss?

Carpal bossing typically only affects your dominant hand, but it can occur in your nondominant hand or both hands.

You’ll notice a firm bump or lump that doesn’t move on the back of your wrist or hand. It’s usually painless, but some people experience pain when they move their wrists. You may also experience tenderness when you touch it.

In addition, a carpal boss can irritate the tendons that run over your hand. Some people feel a snapping sensation of these tendons when they move over the boss.

What causes carpal bossing?

Healthcare providers don’t know the exact reason some people develop them. But some carpal boss causes may include:

• Osteoarthritis: Breakdown of cartilage at your joints, so your bones rub together.
• Congenital issue: Incorrect formation of your wrist bones at birth.
• Overuse: Repetitive wrist motions from certain sports (like tennis) or occupations (like construction).
• Trauma: Broken bones, wrist sprains and other injuries to the back of your hand.

What are the risk factors for this condition?

Carpal bosses seem to affect people between the ages of 20 and 40 years old most often.

How is a carpal boss diagnosed?

Your healthcare provider will perform a physical examination and ask you about your symptoms. They’ll want to know when the lump first appeared and if it’s causing any pain. They’ll ask if any particular movements bring on pain and how your symptoms are affecting your life.

Your provider will examine your wrist and move it around in different directions to test your range of motion. They’ll feel the lump to see if it’s hard or soft.

Your provider may request certain tests to diagnose a carpal boss and rule out other common wrist conditions like ganglion cysts, tendonitis and fractures. These tests may include:

• Wrist X-ray.
• Ultrasound.
• CT (computed tomography) scan.
• MRI (magnetic resonance imaging).
• EMG (electromyography).

How do I get rid of carpal boss?

If you have a carpometacarpal boss that doesn’t cause pain (and you don’t mind the lump), your healthcare provider will likely keep an eye on it but not actively treat it.

If you’re experiencing pain or other symptoms, carpal boss treatment options may include:

• Wrist splint: A wrist splint keeps your wrist in place so it can rest.
• Ice: Ice shrinks the blood vessels in the area and reduces inflammation.
• Pain relievers: Pain relievers like acetaminophen can help you feel better and reduce swelling.
• Steroid injections: Steroid injections can reduce pain and inflammation when icing and pain relievers aren’t successful.

These conservative measures provide pain relief 70% to 80% of the time. But when they don’t, surgery is a safe alternative.

Carpal boss surgery

Carpal boss surgery removes the boss from your wrist. It’s a simple, outpatient procedure (which means you won’t have to stay at the hospital) that takes about an hour.

First, you’ll receive local anesthesia, which means you’re awake but won’t feel any pain. Then, a surgeon will make a small cut (incision) on the back your hand. They’ll shave down or cut out the boss. They may also remove other areas of damaged bone and cartilage during the surgery.

After the procedure, you’ll have to wear a splint for one week while your wrist heals. You should be able to get back to your typical activity between two and six weeks after the procedure.

Can carpal bossing be prevented?

You can’t prevent most cases of carpal bossing because researchers don’t know why they develop. You may be able to prevent carpal bosses due to overuse by protecting your wrist when playing certain sports. Remember to stretch your muscles beforehand and consider wearing a wrist brace. Your healthcare provider can offer other tips to keep your wrist healthy.

What can I expect if I have a carpal boss?

Most carpal bosses are harmless. They’re noncancerous (benign) lumps on your wrist that typically don’t cause pain and don’t lead to any complications. If you have a carpal boss that doesn’t bother you, you can leave it in place and not worry about treatment. Your provider may want to monitor the boss to make sure it doesn’t change or grow.

But in some cases, a carpal boss can cause pain or discomfort. This can occur if the boss is pressing against a nerve or rubbing against another bone. You may find it difficult to use your hand or flex your wrist in certain ways. In this case, talk to your healthcare provider about treatment options. Nonsurgical treatment options may be all you need to provide relief. If these options don’t work, your provider may recommend surgery.

When should I see my healthcare provider?

If you have a new lump or bump on the back of your wrist, talk to your healthcare provider. You might mistake a carpal boss for other health conditions like ganglion cysts. A ganglion cyst shares many symptoms with a carpal boss. They’re both typically painless bumps on your wrist. But while a carpal boss is hard, a ganglion cyst is soft and fluid-filled. Your provider will be able to determine what’s affecting your wrist and whether you need treatment. They’ll want to rule out any serious conditions.

What questions should I ask my healthcare provider?

If you have a carpal boss, you may want to ask your healthcare provider:

• Do I need treatment right now?
• Which treatment options do you recommend?
• What are the chances the carpal boss will return after treatment?
• When would you consider surgery to treat my carpal boss?
• What are the risks and benefits of carpal boss removal surgery?

A note from Cleveland Clinic

What’s that bony lump on the back of your hand? Meet your carpal boss. Like your 9-to-5 boss, a carpal boss can be annoying. But thankfully, they’re typically harmless and don’t require treatment. Most people can live with them when they’re not causing any symptoms. But if it involves pain, there are options that provide relief. Talk to your healthcare provider if that bony bump is bothering you.