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Case Report of an Adolescent with Carpal Boss

A carpal boss is an area that protrudes (sticks out) at the junction between the first finger bones and the small wrist bones. The condition causes swelling and pain in the wrist and occurs most often in adults, but has been found in children as young as 11 years old. The authors of this article discuss an adolescent, 15 years old, who had a seven-month history of pain in dorsal (back) of the right hand and the wrist. She was since diagnosed with carpal boss.

The patient had not experienced any trauma to the had or wrist nor did she do any heavy lifting with the hand. The pain was worsened when her wrist was extended (stretched out) and if the tendons going to her fingers were pressed upon. X-rays of her hand showed that there was a bony prominence around the metaphyseal area (long part) of the bone at the bottom of the third finger, which led to a diagnosis of carpal boss and wrist extensor tendinitis, inflammation of the wrist tendons.

Treatment for the patient began with anti-inflammatories, medications to reduce the inflammation and a wrist splint. Unfortunately, this treatment didn't provide full relief for more than two weeks and the pain was now affecting her ability to do everyday activities. More testing was done with a computed tomography scan (CT scan), where the doctors saw the bony mass that extended from the third finger. Surgery was done to remove the bony protrusion. After the surgery, the patient wore a resting splint during the day (part-time) and full time at night, for four weeks, while she participated in a therapy program for her hand. One year later, the patient no longer had pain and was no longer limited in using her hand.

The authors of this article discuss the issue of carpal boss, which is often mistaken for a ganglion, a small, hard bump usually above a tendon and surrounding or enclosing a joint. Doctors often say that a carpal boss is caused by bone spurs that have formed around the joint, either due to degeneration or trauma. Because adolescents rarely have degeneration of their bones and joints, if they develop a carpal boss, it's most likely due to the bone not fusing properly when they were developing as a fetus.

One study, done by S. Fusi and colleagues, looked at 116 patients who ranged in age from 11 to 75 years. The majority of the patients (94 percent) were relieved of pain after treatment, with seven patients having recurrent symptoms or pain. Similar findings came from a study done by Cuono and colleagues, whose patients ranged in age from 11 to 62 years. The problem with these studies is neither described the effectiveness of treatment for the pediatric population as opposed to the adult population. Because of this, it isn't possible to tell if surgery is effective for a child's still growing bones.

References: John T. Capo, MD, Nathaniel S. Orillaza, MD, Philip K. Lim, BS. Carpal Boss in an Adolescent: Case Report. In Journal of Hand Surgery. Dec. 2009. Vol. 34. No. 10. Pp. 1808 to 1810.

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