Carpal Boss
A firm bony prominence on the back of the hand near the base of the index or middle metacarpal.
What is a carpal boss?
A carpal boss is a bony prominence at the dorsal carpometacarpal region, often involving the bases of the second or third metacarpals and adjacent carpal bones.
Symptoms
Many are painless. Symptomatic bosses can cause local tenderness, discomfort with wrist extension, irritation of overlying extensor tendons or pain during repetitive loading.
Diagnosis
The firm fixed character and location are useful clues. X-rays can demonstrate the bony prominence; ultrasound or other imaging may be used when a ganglion or tendon problem is also suspected.
Treatment without surgery
Activity modification, anti-inflammatory treatment when appropriate, short-term splinting and selective injection may help symptomatic cases.
When surgery is considered
Persistent function-limiting pain despite non-operative care may lead to discussion of excision or treatment of an associated arthritic joint.
Recovery
The goal is symptom relief while protecting joint stability and extensor tendons. Recurrence or persistent pain is possible.