Lumps in the adult hand (and wrist).
A lump in the hand or wrist can be caused by many things. To get an accurate definite diagnosis, we recommend seeing your GP, who may refer you for imaging, or to see a specialist doctor.
Some lumps can be diagnosed by an experienced clinician with a physical exam, sometimes tests such as an x-ray, ultrasound scan or even MRI are needed.
The vast majority of lumps in the hand are benign, but if there is any suspicion of the lump being malignant (cancerous) you may need a biopsy.
Lumps can be superficial (in or just under the skin) or deeper, the colour can vary, the softness and mobility can vary. This guide is just that, a guide only, not a definite diagnosis of any lump, whatever the location or appearance. Only a qualified doctor can make a diagnosis, and if you have a new lump in the hand, we strongly recommend that you see a doctor.
One of the most common lumps is the ganglion, a fluid or gel filled lump that occurs when joint fluid, or fluid around a tendon, pushes out a weakness of the lining, a bit like blowing up a balloon. Ganglia are benign, can be painful and can get quite big. They can occur anywhere on the hand or wrist, but the dorsal wrist is the most common place.
Another benign lump is the lipoma (encapsulated fat). These are very common in other areas of the body, but less common in the hand. They occur mainly in the thenar area- on the palm near the thumb. Lipomas tend to feel soft and are not normally painful. The size can vary, and the can occur elsewhere on the hand or wrist, both palmar and dorsal (palm-side or on the back of the hand).
Calluses and warts
These lesions only affect the skin. Calluses occur mainly in areas where the skin is irritated by friction (palm and fingers). Warts are caused by a viral infection in the skin, and are commonly seen on the dorsum (back) of the hand and fingers in children.
This is a condition where the tendon gets trapped as it tries to move underneath the pulley system in the hand as the finger straightens. This can lead to the finger getting “stuck” in a flexed position. The swelling on the tendon that is a cause and consequence of this sticking can sometimes be felt through the palm skin, and is known as a “Notta’s Node”. As it is attached to the tendon, it typically moves when the finger is bent and straightened.
Dupuytren Disease can cause nodules in the palm or the fingers, also on the dorsal side of the first joint in the finger (there called Dorsal Dupuytren Nodules, knuckle pads or Garrod’s pads), and sometimes on the wrist. These nodules are firm, can be painful, develop under the skin (though sometimes they can be attached to the skin) and in time a cord may develop. The skin over them can appear lighter coloured than normal, due to the tension the nodules cause.
Both osteoarthritis and rheumatoid arthritis can cause different kinds of lumps in the hands. For example, osteoarthritis can cause swellings on the joints, such as Heberden’s nodes (DIP joint), Bouchard’s nodes (PIP joints. Rheumatoid arthritis can cause both swellings of the tissue surrounding the joints (synovitis, often in the MCP joint, or in the thumb) and Rheumatoid nodules. As well as causing pain and inflammation, gout can also cause deposits of white-ish chalky material in the hand.
Giant cell tumour of the tendon sheath
This is another benign tumour, often found on the flexor surfaces (palm side) of the fingers or thumb. It feels solid, and has particular features on scanning that can point to the diagnosis. Mostly these lumps are painless, but the can sometimes stretch the digital nerves.
These are benign growths of blood vessels – either arteries, veins, or lymphatics. They can be diagnosed by clinical examination, and often ultrasound or MRI scanning. Sometimes they have a characteristic colour, for example venous malformations may have a bluish tint. They are benign and not normally painful and occur mainly in the palm.
Foreign body granuloma or inclusion cysts are swellings that tend to occur after a penetrating trauma, either by something being left behind in the wound, or by the trauma pushing a piece of skin deep in the wound. They can occur anywhere where trauma has occurred.
There are a large number of other potential causes for lumps in the hand, and the ones discussed above are simply the most common. Tumours can be both benign or malignant (thankfully rare in the hand), and can affect any of the tissues of the hand, including skin, fat, nerve, tendon, blood vessel, and bones.
If you develop a new lump in the hand, it is important that it is assessed by a fully qualified doctor. In most cases, early diagnosis and treatment (if required) will solve the problem.