Carpal bossing refers to disruption of the carpometacarpal joint (the joints between the second row of wrist bones and the long bones in the hand). This injury is typically caused by axial loading of the metacarpal bones. The joints of the wrist are very precise, like a lock and key, and excessive load in even a slightly less-than-optimal position may expose them to overuse and deterioration. This overuse results in a painful mass of increased bone over the joint. This mass is oftentimes mistaken for a ganglion cyst (which may also co-exist with a carpal boss). Carpal bossing may be asymptomatic, and if so, often requires no treatment. 

For minor chronic bossing a period of deloading to address pain, addressing relevant biomechanics to decrease stress on the affected area, as well as monitoring of the size of the boss, may be sufficient for management. However, in the case of more serious acute injuries, particularly in the index or middle finger, simple wiring is likely required and will result in a good outcome. With more developed bossing, arthrodesis (an artificial fusing of the bones) is likely required for optimal outcomes (1).

  1. Nazarian N, Page RS, Hoy GA, Hayton MJ, Loosemore M. Combined joint fusion for index and middle carpometacarpal instability in elite boxers. J Hand Surg Eur Vol. 2014;39(3):242–248.

About the author

Sam Gilbert

Sam Gilbert is a registered physiotherapist with the Australian Physiotherapy Association (APA) and certified strength and conditioning specialist (CSCS) with the National Strength and Conditioning Association (NSCA). He holds a bachelor’s degree in Physiotherapy from Latrobe university (Melbourne, Australia) and a master’s degree in Exercise Science (Strength and Conditioning) from Edith Cowan University (Perth, Australia).

A 3rd Dan black belt in Shinkyokushinkai Karate under the World Karate Organisation (WKO), Sam participated for over 20 years in full contact competition, winning multiple state and national titles, and culminating in a 4th place in the heavyweight division of the Shinkyokushinkai World Cup in 2009.

As the co-founder and clinical director of Club 360, the premier multi-disciplinary health and fitness center in Tokyo, Japan, Sam has combined his practical experience with an in-depth study of sports performance in relation to combat sports, and strives to help other combat athletes reach their full competitive potential, whilst at the same time decreasing injury risk and increasing competition and training potential.

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By Sam Gilbert