Carpal Boss or Carpal Bossing
What Is Carpal Boss?
Carpal Boss or Carpal Bossing is quite a common condition which is caused due to natural wear and tear of the joints at the back of the basal joints of the middle or the index fingers.1 Carpal Boss or Carpal Bossing normally causes intense swelling and sometimes pain at the back of the hand and quite often it is misinterpreted as a ganglion cyst when in fact it is not. Carpal Boss or Carpal Bossing is normally seen in people between the ages of 20 to 40.
What Causes Carpal Boss?
To understand what causes Carpal Boss or Carpal Bossing, it is important to understand the anatomy of the fingers of the hand. Usually what causes Carpal Boss or Carpal Bossing is an area of arthritis in the back part of the joint, which means that the cartilage lining the joint becomes thin and wears out and new bones are formed which results in the swelling observed at the back part of the hand. At times, there is also some thickening of the soft tissue which also adds to the swelling. It is still not clearly known as to why it affects only some people and not everyone.
What Are The Symptoms Of Carpal Boss?
The classic presenting feature of Carpal Boss or Carpal Bossing is swelling at the back of the hand in the index or the middle fingers. This may at times be painful, but more often than not it is painless.
How Is Carpal Boss Diagnosed?
In order to diagnose Carpal Boss or Carpal Bossing, the treating physician will first start by taking a detailed history of the patient as to when the symptoms were observed and whether there was any history of trauma or injury to the hand or wrist which may have resulted in the swelling. The physician will also conduct a detailed physical examination of the affected area looking for any areas of pain and tenderness. A confirmatory test for Carpal Boss or Carpal Bossing is made by radiologic studies in the form of x-rays which will show area of arthritis at the affected area which confirms the diagnosis of Carpal Boss or Carpal Bossing.2 The physician may also order EMG and nerve conduction studies to look at the status of the nerves in the affected area of the wrist.
How Is Carpal Boss Treated?
Carpal Boss or Carpal Bossing can be treated both surgically as well as by conservative treatments.3 Initially, the treatment begins using conservative approach. This is done by activity modification and limiting use of the affected hand and wrist. In case of pain in the affected wrist and hand pain medications in the form of tramadol and Naprosyn may be given. Gentle massage to the affected area with a muscle relaxant is also helpful in easing the symptoms. The physician may also recommend a wrist splint for immobilization till the swelling is healed and the condition resolves. Also effective is an injection of a steroid in calming down the symptoms.
If the symptoms do not resolve with these measures then surgery will be recommended to resolve the symptoms. The surgical procedure involved is termed as Carpal Boss excision or Carpal Bossing excision. This procedure is performed under local anesthesia. A small nick is created at the affected area of the wrist. The arthritic joint of the hand and any soft tissue abnormality is excised.
What Is The Postoperative Recovery Period For Carpal Boss or Carpal Bossing?
It is extremely vital to take good care of the hands postsurgery for optimal results. It is important to keep the hand elevated. Postoperative medications given by the surgeon should be taken diligently. It takes approximately a week for the bandages to be removed. A follow up is done generally three weeks post procedure to look at the wound. After follow up usually the patient can return to normal activities within two weeks. So overall it takes about six weeks for the patient to return back to normal activities. Postprocedure approximately 90% of patients get rid of Carpal Boss or Carpal Bossing.