What are Tumours of the Hand and Wrist?
A tumour is an abnormal lump or mass of tissue in the body.  There are a number of different kinds of tumors that may occur in the hand and wrist, and over 90 percent of them are benign (non-cancerous, generally harmless).  The list below is a guide to these common benign tumours:

Giant Cell Tumour: These occur on the palm side of the finger, usually to people over the age of 30, somewhat more often to women than men (ratio of 3:2).  A giant cell tumour is a slowly enlarging painless mass. Sometimes patients will have limited tendon function due to adhesions.

Epidermal inclusion cyst: Located on the fingertip or anywhere there has been a penetrating injury.  Seen most often in people between teens and middle age, more common in men.  They are a painless, slow-growing, round soft-tissue mass, and may occur at the site of a finger amputation.

Glomus tumour: Fifty percent of these occur under the fingernail, usually to people between the ages of 30 and 50 years, twice as often to women as men.  They produce a number of symptoms: marked pain, cold intolerance, very tender, with a blue discoloration of the fingernail.

Lipomas: Occur in the padded (thenar) surface of the palm below the thumb and in the first web space of the hand, usually to people between the ages of 30 and 60, with a slight predominance in women.

Epichondroma: Affect the proximal phalange, or lowest portion of the finger, closest to the palm.  They are seen in people between the ages of 10 and 60, and appear to both men and women equally.  They may become painful after a fracture injury.  The finger will appear swollen.

Carpal boss: Located at the base of the second and third metacarpals on the surface of the hand.  Usually affecting people between the ages of 30 and 50 and most common in women. There is a slight bump due to a bony ossicle, a ganglion cyst, and/or a bone spur.

Ganglia: Soft tumour cysts arising from joint capsules or tendon sheaths, filled with fluid.  They can vary in size from a small pea to a golf ball, and are the most common mass occurring in the hand or wrist. Depending on their size and location, ganglion cysts can result in limited joint motion.

Causes of Tumours of the Hand and Wrist?
Little is understood about the cause of these tumors; as a result, there is no known way to prevent them.  Research concerning the cause of malignant tumours has yet to reveal definitive answers as well.

Symptoms of Tumours of the Hand and Wrist?
It is very unusual for primary malignant tumours and skeletal metastases to occur below the elbow.  The most common malignant tumor of the hand and wrist is squamous cell carcinoma.  If you have been diagnosed with cancer or if malignancy is suspected in the hand or wrist, an extensive set of medical protocols is normally undertaken.

Most benign tumours of the hand and wrist are painless, posing no problem besides irritation or occasional discomfort unless there is traumatic accidental injury to the hand.  Cell masses located near joints may become painful because of the movement of the joints. Sometimes there is skin atrophy, change in the fingernails, or associated infection, depending on the nature of the tumour.  Drainage is a problem occurring with epidermal mucoid cysts.  Fracture of the lowest bones of the finger is possible with epichondroma. Lipoma may result in compression of the nerves, producing numbness or changes in sensation.

Treatment of Tumours of the Hand and Wrist?
If you notice changes to your hand and wrist, especially a painful or expanding mass, or one that interferes with the function of your hands, seek medical treatment as soon as possible.  Your doctor will examine your hands, inquire about your medical history, and ask about other conditions of the hand, wrist, and forearm.  In most cases a medical diagnosis will rule out the possibility of malignancy.

Because of the variety of possible tumors, each of which is specific to particular features of the hand, treatment will depend on your doctor’s diagnosis.  Careful examination is required to pinpoint the position and unique characteristics of the mass.  Sometimes x-rays are used to reveal calcification or associated fracture, as in the case of carpal boss or enchondroma.  Your doctor will probably press a small flashlight against the mass to see if it transilluminates; ganglion cysts will show illumination, whereas inclusion cysts will not.  Cysts located near the fingertip often cause the fingernail to arch upward.

Your doctor may test for glomus tumors by noticing increased pain with pressure on the fingernail or with immersion of the fingertip in cold water.  In these cases, a blue or red area may be visible under the fingernail.  Sometimes a foreign body beneath the nail is the cause of the discomfort.

Most lipoma are well-defined, soft, non tender masses that do not deeply penetrate the skin.  Sometimes lipoma on the wrist or palm cause entrapment of the ulnar or median nerves; these require a careful neurological examination.

Your doctor may use a needle to draw a fluid sample from a ganglion cyst.  These cysts tend to fill up again with fluid.  It is important to refrain from trying to “smash” the cyst with a heavy object.  While this may initially seem to solve the problem, ganglion cysts inevitably fill up again with fluid, and home remedy attempts to remove them can result in serious injury to the wrist.

Ganglian cysts do not require treatment unless they cause discomfort.  Your doctor may advise you to put ice on the cyst for 20 to 30 minutes three or four times a day, or at least once daily, until pain is relieved.  He or she may recommend aspirin or other non-inflammatory medication.

Sometimes, if a cyst is painful or unsightly, patients elect to have ganglion cysts surgically removed.  Surgery to remove a cyst involves making a small cut through the skin.  In most cases the cut heals quickly and leaves a small scar.  Ganglion cysts sometimes disappear mysteriously without treatment.

Benign tumours of the hand and wrist may present occasional discomfort, and your doctor can make recommendations about the care of your hands, pain management, and exercising the hand to maintain dexterity in spite of the tumour.  It is important to report any changes to your hands occurring over time.