5 Common Causes of Hand Lumps

Lumps are swellings on the hand which occur due to numerous causes. Most of these swellings are painful, while others are painless and do not require immediate medical treatment.

However, there are specific features of a hand swelling that requires urgent examination by a hand surgeon.

This article will discuss some types, features, and treatment options of common lumps in the hand.

DUPUYTREN’S CONTRACTURE

Dupuytren’s contracture is a deformity in the hand due to the thickening of fibrous tissues underneath the skin. These abnormally thick fibrous tissues form a knot that pulls on the fingers, especially the ring and little fingers. Fibrous tissue thickening occurs gradually and progresses to form a small lump under the skin.

The cause of Dupuytren’s contracture is not known but some risk factors are:

· Sex: Common in men

· Age: Individuals above 50 years.

· Family history

· Intake of alcohol and tobacco use.

· Diabetes

Symptoms of Dupuytren’s contracture include:

· Early signs: Thickening of the skin and painless lump in the skin.

· Late signs: Presence of thick fibrous bands along the ring and little finger that pull the finger inwards.

Individuals with Dupuytren’s contracture are unable to straighten and use these fingers to perform some tasks.

Clinical examination for the presence of a fibrous band in the hand and inability to place the palm flat on a table suggests a contracture.

Treatment options vary but include injection of steroids, radiotherapy and surgery.

TRIGGER FINGER

Trigger finger is a condition in which the fingers lock or get stuck when bent.

It occurs when the space in a tendon sheath narrows due to inflammation.

Symptoms are:

· Stiffness in the finger

· Clicking sound when the locked finger is moved.

· A lump at the base of the affected finger.

· Pain on straightening the locked finger.

Trigger finger is common in people who engage in activities that involve repeated and prolonged gripping of objects and those with medical conditions such as rheumatoid arthritis and diabetes.

A physical examination of the finger with the presence of swelling at the finger base and locking of the finger is suggestive of the trigger finger.

The treatment options depend on the severity- mild cases are treated with a splint, analgesics, and specific finger exercises while severe cases require surgical intervention.

Early diagnosis and immediate intervention reduce the chances of developing severe trigger fingers.

RHEUMATOID ARTHRITIS OF THE HAND

Rheumatoid arthritis occurs when the immune system in some individuals with the genetic predisposition creates self-destructive antibodies that cause inflammation in the joints.

The inflammatory changes in the hand damages the joints in the hand which results in joint swelling, joint pain, warmth and carpal tunnel symptoms such as numbness and tingling sensations in the affected fingers.

Diagnostic markers of rheumatoid arthritis in the hand are:

· Joint stiffness in the morning

· Presence of fluid or swelling around affected joints in the hand.

· Firm swellings under the skin of affected joints in the hand.

· Radiological tests such as X-ray of the hand which shows signs of joint damage and inflammatory changes of the affected joints in the hand.

The treatment of rheumatoid arthritis involves using drugs such as pain relievers and steroids to reduce the degree of inflammation and hand exercises to reduce joint stiffness. Surgery is necessary in only severe cases of extensive joint destruction.

Being a progressive and destructive joint disease, rheumatoid arthritis requires early treatment to halt the progression

CARPAL BOSS

Carpal boss is a bony lump found on the back of the hand where the hand bones meet with the wrist bone. It is common in people with a history of repeated injury to the wrist joint. Carpal boss is usually painless but may become painful when the affected wrist is moved.

Diagnosis of Carpal boss is made by taking a clinical history and physical examination which reveals a hard lump; this feature differentiates it from other similar swellings in the wrist.

Carpal boss treatment requires the use of medications such as analgesics to relieve pain and injection of a steroid into the lump.

Surgery is indicated for the removal of the lump when medications are not relieving the symptoms and for cosmetic reasons.

HAND TUMORS

Hand tumors are swellings in the hand due to excessive growth of the tissues in the skin or underlying bone. These hand tumors may be cancerous or benign growth though the majority of hand tumors are non-cancerous.

Hand tumors require a thorough physical examination and microscopic examination of tissue samples to distinguish cancerous tumors from benign ones.

The most common non-cancerous tumors are:

· Ganglion cyst: It is a painless fluid-filled swelling located on the back of the wrist. When the size increases, it evolves to become painful, associated with the inability to move the wrist as the size increases and tingling sensation.

Diagnosis is mainly by physical examination but Xray may be done to rule out arthritis.

A ganglion is often times not treated because it is small and painless. As the size increases and it becomes painful, surgical removal of the cyst.

becomes the best treatment option.

· Giant Cell tumor of the tendon sheaths: This is a non-cancerous growth from the tendon sheaths in the hands. It is painless and requires surgery when it increases in size and affects the performance of daily activities.

The most common cancerous hand tumors are :

· Squamous cell carcinoma: It is a cancerous growth on the skin in the hand.

It appears a small lump with irregular edges and it bleeds easily.

There are various treatment options including surgery.

· Malignant melanoma: It appears as a pigmented (dark) swelling with rapid growth. It requires early diagnosis and urgent treatment.

WARNING SIGNS OF LUMPS IN THE HAND

Most hand swellings may present without distressing symptoms initially but later symptoms begin to appear.

Warning signs include:

· Distressing pain.

· Rapid growth of the lump.

· Inflammatory changes such as redness, swelling, and warmth.

· Skin changes over affected areas.

The presence of the signs above is an indication to seek medical attention from a hand surgeon.

CONCLUSION

Lumps in the hand vary in size, features, and causative factors.

Some of these hand swellings have similar features that can only be distinguished by a professional hand surgeon.

It is essential to seek prompt medical examination when you notice sudden changes in your hand swelling.