carpal boss surgery

Carpal bossSo I thought I would resurrect this long-dormant blog to describe my recent experience recovering from surgery to remove a bone spur in my right hand called a metacarpal boss … a bony protrusion often confused with a ganglion cyst. See picture of my hand at left or the X-rays below:

Hand x-rays

Anyway, so I had the surgery a week and a half ago, Oct. 10, 2011, at the Hand Surgery Center in Manhattan with Dr. Steven Beldner. (I thought Dr. Beldner was a good surgeon who took time to answer my questions.) I couldn’t find much information online about people’s post-surgical experiences so I thought I’d blog about it afterward.

To back up a bit. So basically I had this bump on the back of my hand … and had, for years. Dr. Beldner said I was basically born with a bony “pebble” between the joints that caused bone to rub on bone, forming the boss. It was unsightly, but not really something that irritated me on a day-to-day basis … except when I was flexing my hand backwards (dorsiflexion), something I really only did in yoga. But the tendons did have a tendency to “snap” over the bone spur, and Dr. Beldner said that that could eventually cause problems, like a rope rubbing over a bump.

Surgical gown So about a year after I was initially diagnosed I bit the bullet and scheduled surgery. It did not initially seem like a big thing but by that night prior to the surgery I was kinda anxious about it and didn’t get much sleep. I had to report to the surgery center, Phillips Ambulatory Care Center, at 6:30 a.m. on Monday for the surgery. (No eating or drinking past midnight the day of the surgery, although I messed up and had some water in the morning).

Soft cast Getting the injection for local anesthesia in my wrist was fairly painful. The anesthesiologist thanked me for not swearing. And then he put me under. The next thing I remember, I was waking up with my hand and forearm in a soft cast (pictured at left) and a throbbing pain in my right hand. The anesthetic had already worn off! Thankfully they had Percocet.

I arrived at the hospital at 6:30 a.m., had the surgery at 8:30, and had my friend meet me to take me home at around 11:30 … but I actually wasn’t quite ready to leave when she got there. Was still going over things with one of the nurses. And I was maybe a little loopy. But I think we left at around 12:15-ish. We made the right decision to get my pain medicine filled at a local pharmacy rather than waiting in line by the one at the surgical center.

I’m not going to lie: The next 24 hours were kind of rough. Even tho I was on oxycodone, that just sort-of dulled the pain; it didn’t take it away entirely. Even though it was a small incision, I guess anytime you mess with bone it hurts quite a bit. Thankfully Dr. Beldner called me the morning after the surgery and told me that by the afternoon, the pain would have really diminished… and he was right. I actually work evenings and felt well enough that I went into work that night, although I left early and was maybe a little loopy from the oxycodone. I quickly switched over to regular Tylenol, taking my last oxycodone Tuesday night.

Foam thing
Also: I had this big bulky foam thing to rest my hand in! Because I had to keep it elevated at all times to reduce swelling. It was a little more conspicuous than I wanted to be. But I guess it was nice to have something to rest my hand in.

During this time wearing the soft cast I had to wrap my hand in a plastic bag and seal it with tape so I could take a shower.

Removable splintBut … as of Wednesday, Oct. 17, I am out of the soft cast and into a removable splint. It still hurts to make a fist or flex my wrist. Even though the skin has healed, Dr. Beldner says he had to displace ligaments from the bone in order to remove arthritis that had developed in the joint. The ligament is currently sutured down to the bone, but it will take four to six weeks to heal. I have to be careful with it, otherwise I could bust the sutures and need more surgery. Eek! But as long as I keep my wrist immobilized, it is really not THAT uncomfortable. Still, no yoga for awhile, alas.

Hopefully I will look back from this in a few months and be like, it was all worth it!!

Anyway, I guess everyone’s experience with surgery is different… but that has been mine, so far.

UPDATE 2/21/2012: I’m happy to answer any questions people might have about my own experience in the comments… but keep in mind, I’m not a doctor, just a dude that had the surgery. I can’t predict what your experience will be like if you end up having the surgery, or give you any medical advice.

UPDATE 3/18/2014: So it’s been 2 1/2 years since I had the surgery! And I’m certainly glad I did. I would say it took about a month or so for my hand to get back mostly to normal, a few more months until a firm handshake or a rap on the knuckles wouldn’t make me wince, and a year until I didn’t notice any real difference between my hands doing yoga. Read some of my comments to this post from the beginning to get the various updates as I gave them.

123 comments to carpal boss surgery

  • Anthony


    I’ve played for almost 2 years since being diagnosed. No surgery. Pharmaceuticals only. I played about 60 times in 2013 with hardly any pain. I take Ibuprofen the night before I play and then take more about an hour before tee time. I fiddled with Aleve and decided that it worked but I wanted to start slower with meds since I don’t know what the future holds and didn’t want to start building up a tolerance. Since the Midwest winter was so bad, I didn’t hit a ball from Nov until about 2 weeks ago.

    Unfortunately, the Ibuprophen isn’t doing as much good so far (I’ve played 5 times in the last 2 weeks.)I’ve found that I start having some pain after about 6 or 7 holes and then the rest of the round I try to manufacture a swing and grip that doesn’t hurt as much. I also discovered that shaking hands with people does not help so I’m avoiding that – awkwardly at best. I’m contemplating going back to the doc for a new look with Xrays or fluorscan to see if the thing has grown. However, I decided after yesterday’s round to increase the Ibuprophen dosage and see if that helps. The good news (everything is relative) is that I haven’t had the intense shooting pains that I did before seeing the doc 2 years ago. As far as my own case goes, the drug seems to work. I haven’t changed my grip (I tried that when I first noticed the knife in the back of my hand. It didn’t really help at all. The pain was bad no matter what grip I tried.)

    I don’t know if this is of any use to you. I’ve read enough about the boss issue that it seems that everyone has a little bit different issue. When I told a surgeon friend about this originally, he was surprised that I had managed to develop such an obscure malady and even more surprised that I had found a doc who had dealt with it before. The one thing I would suggest to you is make sure your doc knows the subject. You saw in my other post that the guy I saw first didn’t. They do not all know everything and your best advocate is you. Ask questions and don’t hesitate to get another opinion if you aren’t comfortable with the first or even second. Regarding your course of treatment – re read my first post. My cortisone shot only worked for days. The Ibuprophen worked better. I’m not suggesting that you do what I did – I’m only saying that conservative treatment worked for me for almost 2 years.

    I’ll stop there. I hope it helps a little. I’ll check back here in a few days in case you have any questions.

  • Jay-C

    I’ve noticed a carpal boss on my right wrist about 3 years ago. I suspect it was caused from doing handstand push-ups…

    After reading several comments on this blog, I’ve realized that this surgery is very risky. Since my carpal boss isn’t causing me too much pain, I had decided I wouldn’t go for the surgery. However, lately I have been weight training seriously in the gym and noticed that my grip strength on my right hand is a lot weaker that on my left hand. I’m suspecting that my carpal boss is partially blocking the signal sent from my nervous system which would result in a weaker grip strength.

    Anybody else noticed the same thing?

  • Claire

    Hi I just wanted to check with you that you would out way the risks in favor of the surgery? I have the same metacarpal boss you had on my right hand and it’s bothering me everyday. Did you get informed about scarring and infection risks involved?? Do you get stiffness in your hand? And lastly, would you know how much the surgery costs? I have seen a surgeon about this, he did say it is unusual in someone who is 26 which is how old I am (had it since 18 though) but if it is causing me problems would perform the operation. I am worried about function afterwards.

    Thanks very much

  • Hey Claire. I don’t recall ever talking to my doctor about scarring or infection risks. There is a scar where he made the incision, but it’s pretty minimal. It’s certainly less unsightly than the boss was. I would read through everything I wrote at the time for more details about what I went through; it’s more accurate than me trying to remember it all three years later. I mention in the comments somewhere how much the surgery cost my insurance company.

  • Jes

    Good afternoon,

    I have had a carpal boss for many years (+10) that never really caused me any problems. I have been practicing yoga for a couple of years, and about a year ago noticed pain whenever I did plank pose or any post that put my wrist at 90 degrees (downward dog was fine). I went to a hand doctor who noticed I had a small cyst in my wrist a little ways below the carpal boss. He aspirated it, injected a steroid, and I was good to go in a week. I practiced pain-free yoga for 6 months. Unfortunately, it appears that the cyst has returned and is deeper so not as easily aspirated. I had an MRI, and Thursday I meet with the doctor about whether or not to do surgery. He recommended surgery, but is waiting to see the results of the MRI. He also said that in the process he could remove the carpal boss. I was initially told I would not be able to do any yoga or weight lifting for at least two months. My question for you is how long before you were able to actually do yoga? (Let me be clear that I will follow any of my own doctor’s recommendations — I am just curious what your experience was like). Can you do crow pose now? Do you wear any type of wrist supports–if so have you found a particular brand that you recommend?

    Thank you for your time. I found your blog extremely helpful, and I hope your yoga practice is going well.


  • Leonie Gava

    Hey! I’m so nervous about going to docs! I first had mine pop up whilst I was working as a zookeeper about 9 months ago. It’s not been nice. It aches a lot and is quite uncomfortable especially when lifting things and mopping etc.
    I now work in a rescue centre and I’ve just about had it with the aches and pains. I went to the docs who said it was a ganglion, but it’s hard like bone, doesn’t move, is exactly where carpal boss’ are found and it doesn’t disappear when I flex my wrist back and forth (which also hurts)
    I am so worried about the recovery time though! My job is pretty full on hands on wise and the recovery sounds long :(

  • Jay-C

    Hi Derek. I decided I would first try a shot of cortisone to see how my hand reacts. Did you try that before going for the surgery ? Also, my orthopedist told me I would lose some permanent grip strength if I get the surgery. Did you feel you lost grip strength since you had your surgery?

  • Hey Jes – Sorry I’m just getting to your question now. I think it took me about a month or so before I could do yoga? It’s been so long, it’s probably more accurate to rely on what I’ve written here than my memory tho.

    Jay-C – Nope, as I wrote, I didn’t have any pain really associated with the boss so what would be the point of getting a cortisone shot. And no I don’t feel like I’ve lost any grip strength.

  • Jay-C

    So if you did not have any pain really associated with the boss, did you get the surgery done because you lost mobiblity in the wrist ? Because in my case, I did not lose any mobility in the wrist but I do feel some pain everyday. Although the pain is only about 1-2 on a scale of 10, it’s bothering to have to live with this pain everyday…

  • Hey Jay-C, read the post again, I know I answer this question!

  • Nicola

    Just had this op. Not quite 48 hours yet. Not too much pain, but a bit dull headed/ tired from general anaesthetic. I’m only taking one ibuprofen alternating with one paracetamol every 4 hours since first 24 hours lapsed. Although might take two occasionally. This blog helped, glad I’ve done it. Mine had started to cause discomfort over last year, as had grown and was interfering with tendon movement…dull ache around area and oddly my lower arm felt desensitised/slight numb feeling. I am hoping this op will fix these symptoms. Time will tell.

    Finger exercises are already easier. Cast apparently on for 3 weeks, with some rehabilitation physio. For me it’s a small price to pay for hopefully avoiding long term wear and tear issues.

  • Ben

    Hi I’m going into surgery on dec 9th to have my boss removed. I’m a contractor and have dealt with this pain for 8 years with steroid injections. My carpal boss was caused by hard physical repetitive movement over a short time (breaking up ice every morning on a job one winter with a heavy metal bar). My question is financial. Does anyone know if this surgery is elective and how much was the patient is responsible for? If anyone can remember what there bill was after surgery I would like to know. By the sound of it I will be out of work for at least a month.

  • Lea

    Hi, I had surgery for a carpal bossing in November 2014. I have had a different reaction to this surgery than what I have read, hopefully someone can give me some positives on this. It has been over 6 weeks now and I still have swelling (apparently scar tissue) where the surgery was. I have been told it won’t get much better than this, but it is far bigger than the bossing was! and my hand is still very sore and still can’t put weight on it. I also had carpal tunnel surgery at the same time, so maybe the combination of the two was not so great. I am doing all the right things as far as exercising the hand etc, but just want to know if there is something else that I can do to improve this result.

  • rachel mays

    Thank you so much for this blog! I am in highschool and currently have my right hand in a hard cast because not only did it bother the tendons, it also ended up hitting the nerve that goes into my index finger and the next to it! I will have surgery asap but i am worried about the risk factors with the main nerve involved? Also i am a very intense runner and have track season for the next three months… how long did it take to recover to the point of activity like running? Thank you!

  • Hi Rachel,
    I went for my first run outside on the 21st, after having surgery on the 10th. For awhile before that I used the elliptical machine in the gym. Can’t answer your question about risk factors with the nerve, sorry.

  • rona venturine

    Hi, I just had that surgery. I still afraid of getting better. I felt better after reading some comments. It is only 15 days, and I am going to therapy, which I am so nervous, it will busts, OMG. My tendons are very painful, I am trying to move as much as possible, I want to go back to work as soon as I can. I hope Ive done the best decision. House is up side down. lol. Moving the fingers alone, it hurts so bad.

  • Juliet

    Did the bossing grow back? My doctor said it has a chance in growing back after surgery and doesn’t recommend surgery for me.

  • Danie Wright

    I am a Baseball player from Huntsville, Alabama. I have been diagnosed with the same thing as you, except with me pitching, I have a lot of pain. I struggled quite a bit this year due to the bone spur in my throwing hand, and decided to get it checked out once the Season was over. They saw it immediately on the X-ray, and scheduled surgery for this upcoming Wednesday. I am committed to the University of Memphis, and I would love to be able to help my summer team as much as I can… how long will I be out due to surgery?

  • Jennifer

    Hi. I am currently 34, at 20 i started experiencing discomfort in my left (im right handed) hand. The feeling is of an elastic band flicking inside the top of my left hand. I then noticed i had a hard bump on the dorsal part of that hand. I went to an Orthopedic Surgeon, his initial thought was that i had been in an accident of some sort that caused a blow to that hand, but was not the case. At 20 i had already been an admin assistant for 4 years. Was then identified this was likely caused by Arthritis from repetative actions. Due to my age, surgery wasnt presented as an option, i instead was given a Cortisone injection into the affected area. For me this was a HUGE mistake. I ended up with severe skin atrophy, which cause me to lose about 70% of the skin on the top of my hand. I was told a skin graft would be my only option if it did not come back naturally. I stopped going to see the doctor. I had braced the hand while at work, and this had seemed to do the trick for the past 14 years, about a month ago i noticed the bump was back or bigger then ever. (for the 13 yrs or so, i hadnt noticed a single thing). So back i go again, my GP told me the flicking/elastic i feel, is because the Boss is so large the tendons actually get caught up on the bone when i move my fingers. Its the creepiest feeling. I am now waiting to go back to the same surgeon after 14 yrs, think surgery could be my only option, as right now using teh hand at work to type, by the end of teh day, i can barely move that hand it throbs so badly.

    I will update again after i see the surgeon. Glad i found thsi thread, there is So much more information available on the web now compared to 14yrs ago.

  • SLS

    Thank you for the blog!
    I just had mine removed about 2 weeks ago. Instead on my left hand. I had surgery at 6am and got out by 9am. I woke up just fine from anesthesia but the evening of was terrible. Actually, I felt no pain from my hand, but the antibiotics and pain killer(vido) kept me very ill and dizzy for the next two days. My doctor advised to slow hand movements and to exercise my hand via making a fist or moving my fingers. I will be going back in a week for a check up and hopefully take off soft cast. Everything seems fine my pointer finger has a sharp pain if I point it down in a fist position. It was like not this the few days before.
    I decided to have mine removed b/c my tendon would often snap over the bone mass when I moved my pointer finger and middle finger. Also since I was diagnosed with this for over 5+ years as a ganglion cyst, and I now in my early 20’s. I cannot hold things properly with this hand depending on the day, and cannot lay my wrist down (example: pushups; hand position).

  • Ryan B

    I am glad I found this site before all I could find was random websites that pretty much state the same thing. I had been having issues with my hands since September 14′ which I was then diagnosed with psoriatic arthritis and started humira. Back when I was having my flair ups there was no sign of the carpal boss I know cause I had been taking photos of my hands to share with my Rheumatologist. Fast forward to early May out of the blue I happened to notice this hard lump on my hand at first everyone one said it was a cyst. So I went to see a hand specialist and he diagnosed the lump as a carpal boss so of course I had some question about it for him about how it just seemed to show up out of nowhere. He told me that it had not and that it has been there since birth which I thought was odd since it was seen in any of my previous photos I had taken earlier in the year.

    Has anyone else’s carpal boss just seemed to form out of the blue? I am also not sure if the humira is also playing a role in it forming some of the articles I have read said that it can be caused by arthritis. My other question is has anyone else’s grown over time or has it stayed around the same size?

  • Jesse

    Really happy for this thread. I’ve got a pretty big carpal boss on my right hand. It causes me pain on a daily basis and if I bump my hand or do any extended excercise, I pay for it. Cortisone shot really helped. I had one shot so far and it helped for a couple months. My Dr. Seems to be reserved about me getting more injections as he did not give me another on my last visit. Just got an MRI and am waiting for results. I feel like I want this thing gone.

  • Donni

    Thanks for the blog. I’ve got the same issue and very helpful to have a patient’s perspective.

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