Have a Carpal Boss?

What is 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 it probably won’t cause the same level of pain and suffering.)

“A carpal boss occurs on the back of the wrist where the pointer finger and middle finger meet the wrist bones,” says hand specialist Yuji Umeda, MD, PhD. “Most people can live with it when it’s just an unsightly condition. But if it involves pain, there are options that provide relief.”

What causes the carpal boss?

The hand lump is also known as a carpometacarpal boss or a bossing. While you can call it whatever you want (maybe Howie?), it’s a good idea to have a physician rule out other conditions like a ganglion cyst or a tumor. “Usually, an X-ray or ultrasound is all that’s needed to diagnose a bossing,” says Dr. Umeda.

Doctors don’t always know how carpal bossings originate but believe they may be related to:

• Osteoarthritis: Breakdown of cartilage at the finger joints, so bones rub together.
• Congenital issue: Incorrect formation of bones at birth.
• Overuse: Repetitive wrist motions from sports (such as tennis) or occupations (such as construction).
• Trauma: Smacking the back of your hand.

The carpal boss believes in equal opportunity: It occurs at similar rates in men and women. Typically, the boss strikes around age 40, but could be earlier. You’ll usually have a boss on just one hand, but it may affect both.

Hey, Howie, stop bossing me around!

“Only 10 to 20% of people get a carpal boss, and the majority don’t have any symptoms other than the protrusion,” says Dr. Umeda. “About 3% of people have pain along with the bossing.”

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

If your boss causes pain, these treatment options may help:

• Wrist splint immobilizes the wrist so it rests.
• Ice contracts the blood vessels in the area and reduces inflammation.
• Pain relievers help you feel better and reduce swelling.
• 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,” says Dr. Umeda. “But when they don’t, surgery is a safe alternative.”

In an outpatient procedure with local anesthesia (so you are awake but don’t feel pain), surgeons will remove the boss from your life. Voila! No more pain. Well, you may have a short recovery, but eventually you’ll forget all about that overbearing boss.