Lumps and bumps

What are Lumps and bumps?

Lumps and bumps are abnormal growth of soft tissues and in some cases from bone. They are usually considered as tumours and can grow anywhere in your body. They are commonly present on the skin of hand or wrist. They are usually benign (non-cancerous) and harmless.  They can affect any tissue of the hand i.e. skin, fat, tendons, nerves, blood vessels, ligaments, bone etc. They may range from conditions like cysts, tumours, masses and even cancer. They can be soft or hard growth, mobile or fixed, size of pea or golf ball. 50 % of the lumps on the hand and wrist are ganglion cysts.

The common types of lumps and bumps in the hand are-

  1. Ganglion cysts- it is the most common type of bumps on the hand. It occurs usually in the wrist, finger joints and at the base of fingers. The ganglions that occur in the end joints of finger are also called as mucous cysts.
  2. Giant cell tumour of the tendon sheath – it is the second common type of hand bumps or lumps. They are noncancerous, slow-growing and solid in texture.
  3. Epidermal inclusion cyst- they usually develop in the areas of hand where there is cut or puncture in the skin.

Less common types of the lumps and bumps are lipomas (tumours of the fatty tissues), neuromas (tumours of nerve), nerve sheath tumours, fibromas, haemangiomas (blood vessels) and glomus tumours.  Dupuytren’s contracture can be one of the causes of the appearance of firm bumps in the hand. Some splinters may render reactions on the hand in the form of bumps.

 

What are the symptoms of Lumps and bumps?

Benign lumps and bumps on the hand are soft and mobile. They are usually painless however some of them could be painful and cause mechanical symptoms. It can be in the size of a pea or as large as a golf ball.  Pain or discomfort is felt with certain activity or movement. Their sizes may get diminished when you rest your hand, ganglions are notorious to disappear and reappear after a symptom free interval.

Some lumps grow quickly (in weeks to months), painfull and could be malignant. They need urgent medical attention.

 

How is it diagnosed?

Your orthopaedic surgeon will ask you for your symptoms and duration of the lumps. He will perform a physical check to find out the type of lump you are having. He may ask you for X-rays, CT, MRI and ultrasound to study the extent of the lump and its relationship to the bone, joints or soft tissues. Needle biopsy or incisional biopsy is recommended to confirm the diagnosis.

 

What happens if nothing is done?

If benign lumps and bumps are left untreated, it may not harm you. It requires treatment only when your lumps and bumps cause pain, mechanical symptoms or size large enough to interfere with your normal activities. It may render pressure on neighbouring nerve – causing numbness and pain, bone – eroding them, blood vessels – reducing blood supply and skin – causing necrosis.

 

How is it treated?

Most lumps could be treated without surgery. Treatment depends on thenature of the lump, size, location and symptoms of the lumps.. Conservative treatment includes skillful neglect, painkillers, splinting, anti-inflammatory medicines, steroid injections, and aspiration.

Surgery could be considered in-

  • To confirm diagnosis
  • Severe pain
  • Failure of conservative methods
  • Mechanical symptoms affecting function
  • Compression of adjacent structures (nerve, bone, tendon etc)
  • Reoccurrence
  • Cosmetic
  • Patient preference

 

What are the non-operative treatments?

The non-operative treatment includes the following-

  • Reassurance
  • Splint- repeated activity may lead to an increase in the size of the cyst and your surgeon may give you a wrist brace or splint to relieve your symptoms. As the pain reduces, hand therapy is recommended to regain the strength of the wrist and improve range of motion.
  • Aspiration– in case you have a ganglion cyst, your surgeon may aspirate the ganglion. He will puncture the cyst with a needle and fluid is withdrawn out of the sac through a syringe. He might inject steroid after aspiration.
  • Cold application- Application of ice packs can help reduce the pain.
  • Medicines- painkillers are often used to relieve pain and tenderness caused by the lump. Anti-inflammatory medicines are prescribed to relieve pain and size of the lump of the hand.
  • Hand therapy– your therapist will teach you exercises to maximize the function of the affected arm.

  

What does the operation involve?

The surgical treatment aims at the removal of the lumps from its site to confirm the diagnosis from pathologist, to enhance the function and reduce any discomfort and pain resulting from the lumps.

  • You are admitted to the hospital and the operation is usually performed as a day case.
  • The operation is performed under general anaesthesia or local anaesthesia (nerve block). In general anaesthesia, the patient does not feel anything and sleeps throughout the operation. In local anaesthesia, the patient remains awake during the operation but he cannot feel whatever is happening in the surgical area. Your anaesthetist can select a combination of both local and general anaesthetic.
  • The Skin is closed using absorbable sutures. The operation takes usually 1-2 hours and the majority of the patients are discharged on the same day.

 

What happens after surgery?

  • The local anaesthetic wears off in 4 to 12 hours after surgery. Patients are given painkillers before the pain starts i.e. on return to home. It is continued for at least 48 hours after the first dose. Thus, most of our patients report little or any pain.
  • You will have a bulky bandage when you wake up, that usually needs to be reduced in 24-48 hrs. You will have spare dressings to take home and have to keep the wound dry and clean for 2 weeks
  • You have to keep your hand and wrist elevated (above the level of your heart) and keep moving your fingers, elbow and shoulder to maintain the flexibility and prevent stiffness of the joints.
  • You are reviewed again after the period of two weeks to check the wound and physical therapy are advised for rehabilitation.
  • The wound should be massaged (typically after 2 weeks) using moisturising cream by the patient 3 times a day for 3 months once the wound is well healed. This reduces the scar sensitivity and scar-related complications (tenderness; helps scar to mature).
  • Physical therapy of hand is essential to restore the range of motion, normal function and strength of the hand.

 

Are there any risks?

  • Bleeding
  • Infection
  • Damage to nerves vessels and tendons
  • Stiffness
  • Hardware problems
  • Non-union
  • Fracture
  • Dislocation
  • Misalignment
  • Persistence of symptoms
  • Need for revision surgery
  • CRPS (Complex Regional Pain Syndrome)

 

What are the results of the operation?

Most patients report excellent results with  fewer complications.

 

When can I return to driving and work?

You can return to your regular work in 2-4 weeks after the surgery. Your surgeon can give you the correct estimation.

 Lumps and bumps on the hand_1

  1. Gouty topic with arthritis affecting finger tip joint
  2. Ganglion at the wrist and finger

 Lumps and bumps on the hand_2

MRI scan of giant lipoma of the hand compressing median nerve

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