A lump in the hand is any abnormal swelling or mass beneath the skin; the vast majority are benign. The hand and wrist contain a complex arrangement of soft tissue, joints, and tendons, providing numerous sites where a mass can form. This overview explores the most frequent causes of these hand masses, distinguishing between simple soft tissue growths and those arising from deeper structures.
Common Soft Tissue Causes
The most common hand lump encountered is a ganglion cyst, accounting for over half of all masses in the hand and wrist. This fluid-filled sac typically arises from a joint capsule or a tendon sheath, forming a balloon-like outgrowth. The fluid within a ganglion cyst is thick, viscous, and jelly-like. These non-cancerous cysts are known to fluctuate in size, sometimes disappearing entirely on their own.
Another frequent soft tissue mass is the lipoma, a slow-growing tumor composed entirely of fat cells. Lipomas are generally found just beneath the skin and have a characteristic soft, “doughy” texture, easily moving when pressed. Although lipomas are the most common soft tissue tumor in the body, they are less frequent in the hand than ganglion cysts. They are overwhelmingly benign and usually cause no issues unless they grow large enough to press on adjacent nerves.
Lumps Related to Joints and Tendons
The second most common mass after the ganglion cyst is the Giant Cell Tumor of the Tendon Sheath (GCTTS), a solid, slow-growing, benign tumor. This mass often develops in close proximity to the flexor tendons on the palm side of the fingers.
Other firm growths include rheumatoid nodules, which are lumps of inflammatory tissue developing beneath the skin. They are strongly associated with rheumatoid arthritis and often appear near joints or over pressure points like the knuckles, ranging in size from a pea to a walnut. A different type of crystal-based deposit is the tophus, which forms in individuals with chronic gout. Tophi are hardened accumulations of uric acid crystals that appear as bulbous, chalky white lumps and may cause joint deformity.
Identifying Warning Signs and When to Seek Medical Attention
Certain characteristics should prompt a medical evaluation to rule out rare but serious conditions. Rapid growth of a mass over a short period of time, such as weeks or a few months, is a primary warning sign. Similarly, a lump that feels fixed or tethered to the underlying bone or deep tissues, rather than being easily movable, requires professional assessment.
A lump that causes persistent or worsening pain, numbness, or tingling suggests it may be compressing a nearby nerve. Changes in the overlying skin, such as discoloration, warmth, redness, or a non-healing open sore, are also causes for concern. Although cancerous tumors in the hand are extremely rare, a medical professional must evaluate any mass exhibiting these red flags to confirm a diagnosis.
Diagnosis and Treatment Approaches
The evaluation of a hand lump begins with a thorough physical examination, where a doctor will assess the mass’s size, mobility, tenderness, and connection to underlying structures. Initial imaging often involves X-rays to check for bone involvement or calcifications, and an ultrasound can distinguish between a fluid-filled cyst and a solid mass. For more complex cases, or when a malignancy is suspected, Magnetic Resonance Imaging (MRI) provides detailed images of the soft tissues and tumor margins.
Treatment depends heavily on the specific diagnosis. Many benign, asymptomatic lumps, such as small ganglion cysts or lipomas, are managed with observation. For symptomatic fluid-filled cysts, non-surgical options include aspiration, where a needle is used to drain the fluid, sometimes followed by a steroid injection. Solid masses or lumps that cause pain, restrict movement, or raise suspicion of malignancy typically require surgical excision, which is usually curative for most common hand masses.