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.

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