Carpal boss; Is it a serious problem?

carpal boss; Is it a serious problem?

Carpal boss is a healthy bony protrusion that appears in the wrist of the hand. The protrusion may cause symptoms that impede the movement of the wrist, and some may consider it a deformity in the shape of the hand, but it may indicate a more serious problem.

The main cause of wrist bone protrusion is unknown, but it occurs frequently in cases of bruises and repetitive sports activities such as golf and tennis. A bony prominence in the wrist is common in adults between the ages of 20 and 40 and occurs equally between both sexes. These bone spurs usually do not cause symptoms, but the main problem is the appearance of a bone spur in the wrist only. 

Most of the bony bumps on the wrist are benign protrusions that do not cause any problems, but it is necessary to identify the causes of Bone protrusion in the wrist and its symptoms, methods of diagnosis, and treatment to distinguish it from other more serious diseases such as ganglion cysts (synovial cysts) or tumors. 

An image showing a wrist knuckle is a carpal boss
Carpal boss

A glimpse of carpal boss

Bone protrusions are solid bony bumps or masses that form where one bone meets another bone - that is, in the joints - such as the wrist joint. These bumps may appear in the foot, ankle, or on the bones of the spine.

The wrist consists of several bones, which are eight small bones, each of which has a different shape and size. the bones: lunate،scaphoid، triquetrum، pisiform، trapezium، trapezoid، capitate، hamate 

An image showing the carpal bones and the carpal joint between the carpal and metacarpal bones
carpal bones

that Carpal boss It is a bony protrusion that appears in the wrist of the hand at the meeting of the carpal bones with the base of the metatarsal bones (metacarpals), especially the base of the index and middle fingers.

The protrusion of the wrist bone is usually in the wrist of one hand and may appear in the wrists (both hands), depending on the cause. 

Symptoms of carpal boss

Most cases of carpal boss do not cause symptoms. The only primary sign of carpal boss is a hard lump at the back of the wrist.

However, the protrusion may be accidental in some cases, and its symptoms are manifested through the following: 

  • Pain: The cause of hand-wrist pain is the pressure of the bump on the nerve or its friction with the bones of the other hand. Pain may occur when bending or moving the wrist, which leads to limitations in naturally using the hand.
  • Tendon squeak: Sometimes, the sound of the tendons can be heard when they move over the bump, and the squeak may be with or without pain. 
  • Numbness and tingling: The protrusion of the wrist bone may lead to numbness and tingling in the affected area in case of pressure on the nerves.


Causes of carpal boss

There are many causes for the protrusion of the wrist bone, but the main cause for the formation of a bony bump in the wrist remains unknown among these reasons:

  • Atypical development of the bone: a congenital condition in which an abnormal formation occurs in the bones, which may lead to the carpal boss.
  • Overuse: Repetitive wrist motions often lead to the growth of a bony spur in the wrist, such as in sports (golf and tennis) or in some occupations (construction).
  • Arthritis: Inflammation of the carpal joint may lead to an injury to the articular cartilage and, thus friction of the bones of the hand against each other and the formation of bony bumps.
  • Trauma: Traumatic injuries may cause carpal boss, such as accidents that cause Hand fractures or punching something hard (because the force from the punch is transmitted to the wrist).
An image showing the transmission of the force resulting from the punch in the opposite direction of the punch towards the wrist bones and hurting them
Injury to the carpal bones when punching

Diagnosis of carpal boss

Diagnosing the protrusion of the wrist bone depends mainly on the clinical examination, symptoms, and when the protrusion appeared. ganglion cyst (seismic/glumal cyst) ganglion.

An image showing the ganglion cyst that appears in the same place as the wrist bone protrusion and with the same shape and is differentiated from the protrusion by palpation, as the cyst is soft
ganglion cyst

Some tests that show the wrist more accurately, such as X-rays, computed tomography (CT-scans), and magnetic resonance imaging (MRI), can be done better to evaluate the bones and ligaments in the wrist. 

An image showing carpal boss by radiography, through X-Ray
Radiography of the protrusion of the wrist bone

Treatment of carpal boss

The treatment of the protrusion of the wrist bone depends on the type of symptoms it causes and the time of the appearance of the protrusion. When the protrusion is painless, there is no need for treatment. Instead, resting the hand with supervision by a specialist doctor is enough.

But if the protrusion is painful, it must be treated, and the most important step in treating a bone protrusion in the wrist is to avoid hand movements that cause pain. 

Conservative treatment 

It is a treatment limited to managing and reducing symptoms and is recommended as a primary treatment for protrusion. Treating a bone spur on the wrist at home includes:

  • Placing a wrist brace (splint); This is to stabilize and relax the wrist and is usually placed for 4-6 weeks.
  • Putting ice on the wrist area; This is to relieve wrist pain and swelling.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) and pain relievers; To reduce inflammation and pain.
  • Corticosteroid injections: we resort to corticosteroid injections when an accompanying inflammatory condition occurs (tendonitis - periostitis), as they reduce inflammation and swelling.
  • Physiotherapy; This is to strengthen the muscles and improve the position of the wrist, thus reducing pressure on the nerves.

Surgical treatment 

Surgical treatment is the preferred option, but it is usually delayed until previous treatment options have failed or if the appearance of the bulge is bothersome. Surgery is essential to prevent damage to the tendons near the protrusion.

The surgery aims to remove the bump without affecting the surrounding tissues. The surgery is done by making a transverse incision at the base of the metatarsal; then, the bone is removed through surgical tools.

An image showing the surgical work that is performed to remove the protrusion, where a transverse incision is made at the base of the metatarsal, and the protrusion is removed using surgical tools
Carpal boss surgery

The surgery is done under local anesthesia (preferred), regional or general anesthesia, and the procedure usually takes less than an hour.

Some patients may need to have another surgical procedure called. Carpal arthrodesis To remove damaged bone and cartilage to stabilize the wrist, the orthopedist at the medical center may recommend this surgery from the beginning instead of just removing the spur, depending on the symptoms. 

Persistent hand pain and swelling are common after surgery, and it may take several weeks to months for symptoms to improve.

Physical therapy exercises are usually performed with a physical therapist a week after surgery in order to prevent swelling and inflammation in the wrist. The patient can use his hand within a week of surgery and return to usual activities within 2-6 weeks. 

Complications of carpal boss 

may result from the presence of Bone bump in the wrist One of the following complications:

  • Rupture of the tendons of the hand: the movement of the tendons of the hand over the bump may lead to mechanical erosion of the tendon and thus its rupture, and it usually manifests as severe pain.
  • Inflammatory and degenerative joint diseases (carpal arthritis).
  • Damage to nerves and blood vessels.

Prevention of carpal boss

formation can be prevented Bone bump in the wrist Through the following: 

  • Reducing excessive use of the wrist: by avoiding sports that require excessive use of the wrist, such as golf (Golfer's elbowOr rest the joint immediately after feeling tired.
  • Early treatment of arthritis: This is to avoid damage to the joint cartilage and bone friction with each other, and thus the growth of bumps in the wrist.
  • Avoiding emotional outbursts, controlling anger, and knowing that punching a wall won't solve problems; it will only lead to a broken hand.

Carpal boss is usually of unknown cause, but it may occur due to excessive use of the wrist or bruises. It usually does not cause symptoms but only manifests as a solid protrusion in the wrist, and the doctor suffices with observation. Still, when symptoms appear, you must treat it conservatively or surgically because of serious complications such as Tendon rupture; taking medical advice from a doctor specializing in bones and joints will help you feel reassured.


  1. WebMD
  2. Healthline
  3. National Institutes of Health

Common questions

The cause of bone protrusion in the wrist is usually unknown, but the condition is frequent when the wrist is overused, in trauma and arthritis.

Bone spurs are projections that arise where one bone meets another bone (the joints).

The bone spur can usually be eliminated by applying a splint or ice with pain relievers, but surgery is used to remove the spur if the previous treatment fails.

Bone spurs are usually asymptomatic and are only discovered by chance, in which case they do not require treatment. But when symptoms begin to appear, these spurs must be treated based on their location and the extent of their impact on health.

Make an appointment with Dr. Çetin Işık
In Istanbul

Make an appointment with Dr. Çetin Işık
In Istanbul