Carpal boss or bossing is a common condition due to the natural wear and tear of the joints at the rear part of the basal joints in the middle or index fingers. The condition typically causes intense swelling and oftentimes discomfort at the back part of the hand and often misdiagnosed as a ganglion cyst. Carpal boss is often seen among individuals between the ages of 20-40.
What are the causes?
The usual cause of carpal boss is having arthritis in the rear region of the joint. It simply indicates that the cartilage that lines the joint is thin and wears out and new bones form which results to inflammation at the back part of the hand.
At certain times, there is some thickening in the soft tissues which adds up to the swelling. It is still not clear why it develops in some individuals.
What are the indications?
The characteristic feature of carpal boss is swelling at the rear part of the hand in the index or middle fingers. Take note that this can be painful at certain times but usually painless.
Carpal boss can be managed using both surgery and conservative measures. Initially, the treatment starts with the conservative measures such as activity modifications and limiting the use of the affected wrist and hand.
For the pain in the affected wrist and hand, pain medications are given. Gentle massage on the affected region along with a muscle relaxant can help ease the symptoms. The doctor might recommend a wrist splint for immobilization until the swelling settles. In addition, an injection of a steroid can alleviate the symptoms.
In case the symptoms do not settle with these measures, surgery is an option. The procedure is called carpal boss excision which is done under local anesthesia. A small incision is created on the affected region in the wrist. The affected joint in the hand and any abnormalities in the soft tissue is excised.