Pediatric hand and wrist masses

What are the different types of pediatric hand and wrist masses?

 It is important to see a qualified hand specialist to guide the diagnosis and treatment of your child’s particular mass.

There are many types of hand and wrist masses including:

•  A Ganglion cyst is the most common mass in a wrist or hand. A ganglion cyst is a non-cancerous lump that may occur around a joint or the lining of a tendon. They are fluid filled and may feel spongy or very firm. They may change in size, often disappearing temporarily or even permanently. 
  • A cyst usually does not cause pain or functional loss, but some patients do report discomfort with pressure or overuse. 
  • Your hand specialist may diagnose this based on clinical exam or may recommend imaging, such as an ultrasound or MRI. Because this is a benign mass, the treatment could include observation, injection of steroid, draining fluid from the mass (aspiration), or surgical removal.
• Giant cell tumor of tendon sheath (GCTTS) is a benign (non-cancerous) mass. They are very common and usually present as a slowly growing, firm lump that is not painful and does not cause problems with function. Your hand specialist may diagnosis this based on clinical exam or may recommend imaging. Because this type of mass continues to slowly grow and does not spontaneously resolve, the treatment for a GCTTS is usually surgery. The mass will be removed and sent to a pathologist to confirm the diagnosis of GCTTS.     
• Epidermal inclusion cyst is a collection of keratin, a yellow, waxy material that naturally occurs just under the skin. It may develop after a mild injury to the skin or hair follicles. Inclusion cysts may stay small or gradually increase in size. Rarely, they become painful and red, which may be relieved with a warm, moist compress and antibiotic treatment. If the cyst becomes an ongoing problem or continues to enlarge, your hand specialist may recommend surgical excision.
• Blood vessel tumors are a variety of blood vessel tumors that may involve the hand or wrist. These include venous, lymphatic, capillary, arteriovenous, and hemangioma types. Symptoms may include a specific mass or changes to the entire skin surface versus a specific blood vessel. Pain varies with the type of blood vessel tumor. We recommend evaluation with a hand specialist if you have suspected blood vessel tumor of the hand and wrist. The hand experts work closely with our Vascular Anomalies team to coordinate imaging and treatment plans, which may include nonoperative treatments such as compression or sclerotherapy or surgical excision.
• Foreign body - Children often have unwitnessed minor trauma to their hands and wrists. Occasionally, a foreign body, or foreign object, may become embedded under the skin. Our bodies will naturally “wall-off” the foreign body, forming a lump around it for protection. Your hand specialists may recommend observation to allow the lump to resolve on its own, or we may recommend surgical removal.  
• Scar or keloid - Any trauma to the hand or wrist can create scar.  Most scars heal well without problems and do not need intervention beyond simple care of a wound, lotion, and massage. If a scar becomes thick or crosses a joint of the wrist or finger, it could begin to limit function. Occasionally, scars will begin to grow outside their original boundaries, forming a keloid. Burn and traumatic scars found on the palm side of the hand are more often a problem, causing contracture of the fingers and loss of function as a child grows, particularly during growth spurts. 
  • Scars that form aggressively with limits to motion or loss of function should be evaluated by a hand specialist. We work closely with pediatric occupational therapists to maintain motion and function as your child grows.   
• Carpal boss (carpometacarpal boss) is a firm lump usually on the back of the hand located just beyond the wrist at the base of the index or long fingers. Most people do not know a cause of their boss, but it may be associated with repetitive activities. It is often noticed as a pain free lump or may be associated with mild pain or “snapping” feeling of the overlying tendon. They are rare in children. 
  • Your pediatric hand specialists will typically be able to diagnosis and recommend a treatment plan for this type of mass after an x-ray and thorough examination. Because this is often pain-free, observation is usually recommended. Other options may include icing, over-the-counter pain relievers, steroid injections, or surgery.  
• Enchondroma is a benign (non-cancerous) bone tumor that develops when cartilage grows inside the bone. They are commonly found in the small bones of the hand but may occur in other bones in the body. These often have no symptoms when very small. As they grow, the bone will expand to make the finger look larger. The enlarging bone may become weakened and susceptible to breaking.  This is called a “pathologic fracture” and may be the first sign that the enchondroma is present. 
  • Enchondromas are usually solitary, meaning you only have one in a lifetime. When there are multiple enchondromas present, your healthcare provider will investigate to determine if this is part of a condition such as Ollier’s disease or Maffucci syndrome. 
  • An x-ray is typically enough to diagnose an enchondroma, but a CT or MRI scan might be necessary. Observation may be recommended if the mass is small. Your surgeon may also recommend a biopsy, curettage (scraping the tumor out of the bone), or a bone graft (filling the cavity with bone graft).    
• Lipoma is a benign (non-cancerous) fatty tumor. They may occur anywhere on the body, including the hand. These lumps are not dangerous and may be observed without intervention for long periods of time. They do not typically cause pain or functional loss. Your hand specialists will work to determine if surgery is necessary.  
• Neuroma is a benign (non-cancerous) nerve tumor. This may be painful or have some associated numbness. Neuromas may develop without an underlying cause or may be a result of a traumatic injury. The pediatric hand specialists at Children’s Health are experts in providing a treatment plan tailored to your child’s nerve condition.  
• Glomus tumor is a benign (non-cancerous) tumor. It is very reactive to temperature changes and will often become very painful when exposed to cold. They are frequently found in the skin underneath the fingernail. 
  • Your pediatric hand specialist may diagnosis this based on an exam with specific temperature and pressure testing. An MRI also may be required. If a glomus tumor is suspected, your surgeon may recommend surgery to remove the tumor. The removed tumor will then be sent to a pathologist to confirm the diagnosis.  
• Malignant tumors are extremely rare in pediatric hands and wrists. Rarely, skin cancers (such as melanoma or squamous cell carcinoma) or other cancers (sarcomas) could develop. Your child should be evaluated with any new skin changes or masses, particularly with any changes in the color or texture of the skin.  Your hand specialist will then coordinate appropriate work-up and treatment. 
• Joint or bony change in the bone or joint may show up as a mass. Pediatric injuries that occur unwitnessed could lead to a bone healed in the wrong position or a joint that is out of place. These may look like a “mass” but are really a result of a change in the underlying bone or joint structures. Your pediatric hand specialist will obtain an x-ray at the initial visit to identify this type of problem. Treatment will vary based on the underlying injury and stage of healing. 
• Mass following an injury - Your child may have an area of swelling or a lump caused by a solid collection of blood underneath the skin or within the muscle (hematoma). In the hand, the lump could also be from a displaced bone, a joint out of alignment, or a rupture of a tendon. If you have any questions about the source of a new lump after an injury, we recommend an evaluation by one of our hand and wrist experts.

What are the signs and symptoms of pediatric hand and wrist masses?

• A soft or firm lump in the wrist, hand or fingers. 
• Masses are often asymptomatic, which means you don’t have any associated pain, numbness, or functional loss.
• It is possible to have pain or numbness with some types of masses.

How are pediatric hand and wrist masses diagnosed?

There are many types of hand and wrist masses. Your child will receive a thorough exam and x-ray at the initial visit. A pediatric hand expert will determine if additional tests are necessary to diagnose the type of mass. 

This may include:

• Biopsy
• Computed Tomography (CT)
• Magnetic Resonance Imaging (MRI)
• Ultrasound

At Children’s Health, our hand experts have access to a radiology team that can provide quick answers to your concerns with the goal of reducing sedation, radiation exposure, and invasive procedures.

How are pediatric hand and wrist massess treated?

After a detailed examination and review of any necessary imaging, our hand and wrist experts will work to develop an individualized treatment plan for your child. The treatment recommended will depend on the type and location of the mass. 

The goal of treatment is to provide the highest level of care while minimizing invasive treatments. We will work to get your child back to unrestricted daily activities as quickly as possible. 

Therapies offered may include occupational therapy (OT), splinting, steroid injections, aspiration (draining) of the mass, or surgery.