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.

UPDATE 9/8/2017:Since people have asked … no, I didn’t try “steroid injections”. Nor was this discussed as an option. As I have mentioned, this was never something that was causing me pain so I’m not sure what the point would have been. The issue was the tendons snapping over the bone spur.

160 comments to carpal boss surgery

  • judy firestone

    Hope it heals quickly. Surgery sounds quite invasive. Are you able to work properly now??
    I had 3 k wires out of my wrist,(they were holding my broken radius in place. When i fell i also broke the end off the ulna, but that stayed in place pretty well) on Tues, which was freaky, and i didn’t watch!!! no cast now, but my wrist wont bend, and my hand swells up if I do too much. Hand very weak form lack of use….go to see a hand therapist on Tuesday!
    Sounds like you have a good surgeon!

  • Ouch mom! Feel better!!

    I can work fine now. My first couple days back I just used my left hand to do all my typing; now I use both. I can’t quite make a fist with my pointer finger but it is fine for typing.

  • Sue Fox

    I am considering this surgery this Friday because I have tremendous pain when I play tennis. It hurts when I grip my racket. How long is the recovery? do you have full function of your hand now? I don’t know if I should just live with the pain or have surgery.

  • Hey Sue. So after about three weeks, I went to a Bikram yoga class… and I actually felt like that helped my recovery quite a bit. (My surgeon agreed it was probably helpful, by stretching out the ligaments). I stopped wearing the removable splint after that, a week early, because I felt like I didn’t really need it. I would sometimes get a jolt of pain through my hand if I banged it, and it took me another week or two until I could make a full clenched fist without pain.

    Right now the only issues I have with my hand are, a) when someone gives me a really firm handshake it does hurt; and b) when I do “plank” and “full wheel” poses in yoga that hand is still a bit sore and not as strong. I feel like it is slowly getting better though.

    Also I used prescription Voltaren gel I had left over from an ankle issue and it seemed like it helped control the swelling. Voltaren is a NSAID (nonsteroidal anti inflammatory drug), kinda like Advil in topical form. Dr. Beldner was impressed with quickly I recovered and said I didn’t need physical therapy, unlike I guess most people who have the surgery, so I think it helped.

  • tety

    hi derek, i am from brazil and i have similar symptoms.
    I am seriously thinking about doing this surgery but I’m afraid but it was good seeing you.
    and happy new year is best for you

  • Peter

    Hi Derek,
    I had my carpal boss taken out (my hand, not to dinner) two days ago. I found your page a couple of days before that so I was quite reassured that it wouln’t be a long and tedious recovery. I must say my findings are much alike yours, allthough I think the pain is bearable. The only thing that had me bothered was the swelling that made my fingers look like hot-dogs and my hand like a well stuffed turkey. So it’s a matter of icepacks, moving the fingers and keeping it up – which I find to be the most annoying at the moment.
    I hope my recovery goes as smooth as yours. Meanwhile I wish you all the best, maybe you can give an update soon.
    Greetings, Peter

    *typed with one finger 🙂

  • Hey Peter. I don’t really have much of an update for you. It’s been three months and 10 days — the swelling is gone (although I guess if you compare my fingers on my right hand to my left hand, you can notice just a little bit of residual inflammation), and it’s been awhile since anyone gave me a handshake that ended up being painful. Doing plank position (the top of a push-up, basically) still makes my hand a little sore. But for everyday stuff my hand is fine.

    Swelling-wise I suffered inflammation but not nearly as bad as what you’re describing, so keep it elevated!

  • […] derek rose: Hey Peter. I don’t really have much of an update for you. It’s been three months and 10 days… […]

  • Cheryl

    I am glad I found your blog. I just had the same thing done 5 days ago. I also had a cyst removed. It is good to hear you recovered well. I am still in pain when I move it but keep pushing through the pain so it does not get stiff. I had a cyst removed on my other wrist 14 years ago and have absolutely no problems with it. Here’s hoping this one recovers as well. I teach fitness classes so I need it to work. thanks for your info.

    Take care,
    Cheryl

  • JC

    Thank you very much Derek for posting information about your operation. I have the exact same thing you had. It started to hurt after doing handstand push-up almost everyday for almost 1 month. I now do it my closed fist. Much of the pain is gone but it still hurts everyonce in a while, especially when I shake hands. I was thinking of going through a surgery but according to your posting, it seems like the recovery is very long. The pain is not that bad for the moment but I am worrying that over time it might get worse because it’s like a “rope rubbing over a bump”. Before you decided to get your surgery, did it hurt very bad?

  • No, it wasn’t that painful at all pre-surgery JC. Just uncomfortable in certain yoga poses. That’s why i was sort-of second-guessing my decision to have the surgery when I wrote the post. Of course now looking back I’m glad I did. But I still don’t think I could say it is better than it was before the surgery…. Still worse, actually.

  • Morgan

    Hi Derek,

    Thanks for posting this experience. I had trouble finding anyone talking about the surgery and am feeling very nervous. I just found out today I have to have this surgery but I work in a call center and litterally sit and type for 8 hrs straight all day. I read that you had to type with one hand for a while- how long would you say it took for you to be able to type comfortably with both hands? Unfortunately if I am unable to type quickly and with both hands I am out of work so I was just curious. Thanks again for all your details… it’s been so helpful.

  • Hmm. I’m not sure exactly how many days I was typing with just one hand, but I’m sure I was typing with both before I got the soft cast off, so less than a week. Good luck!

  • Paul Meyerherm

    I had surgery on my right hand to remove a bone spur I can not use my hand.When I try to use my thumb for picking up something or to squezz toothpast out of the tube,can not do it.I am going to PT and 4 Pt tech said that this is not normal and should seek a second opinion.The pain now is worse now then before.I might need a lawyer.

  • Nancy

    Hey Derek-
    Thanks for the posting and pics. Now I know what those hard bumps on the top of both of my hands are called! Do you happen to have bone spurs anywhere else? I have a very large, prominent one just under my right knee. None are painful, just very unattractive. Kneeling is out of the question. Do you know what caused them? Something repetitive maybe, like hand weights?

    Thanks again for the posting.

    Nancy

  • Hey Nancy. I also had a bone spur on (or rather, in) my ankle. It never formed a bony protrusion tho — you couldn’t see it. Not even sure if it was related. (I also wrote about it on this blog – anterior ankle impingement syndrome). The hand surgeon just seemed to think the bone “pebble” between the joints in my hsnd was something that I was born with, and eventually it caused my body to form the spur/bump. But people can get them in different ways — I guess boxers get them a lot.

    Keep in mind there is also something called a ganglion cyst, which looks similar but is made of fluid, basically.

  • Liza

    Derek, thanks for your site! I had a carpal boss removed on my right hand. It was causing swelling & pain after overuse, like mountain biking or camping. I also was having difficulty for yoga–so I decided to do just my right hand, which was the one that would swell.

    I had the surgery on 12/15, so it’s been over 2 months. It was not in a cast afterward, and the doctor did not order PT until after I complained that it was larger than before & very uncomfortable. I’ve done 3 PT sessions, have stretches for it and a compression bandage to wear at night, and I am still REALLY regretting having done this.

    It feels like my tendons are forming adhesions. Typing is uncomfortable, and writing by hand is worse. Yoga seems to make it swell. For all of you out there considering this, I have not found solid research supporting this surgery. I would REALLY not do it unless your symptoms are awful.

    The surgeon did warn me that tissue would form over the area, and so it might look worse before it gets better. Well, has yours gone down? I am very concerned that I made a huge mistake. Maybe we should both post pics & update them!!! How does yours compare to the size it was before surgery?

  • zafar

    Derek,
    Thanks for the posts.It is really helpful to decide whether I should undergo the excision of carpal boss on my right (working) hand. Normally I have no pain at all. It pains only when I swing the cricket bat and I don’t know if I can live without playing this game which I adore. I played pro and even at 48 I can still perform. My surgeon says that there is no guarantee that pain will dissipate as well as recurrence of the boss. My wife and daughter are not in a favor of this procedure. Did you tried steroid injections to see whether that would work? I work in front of computers, so I assume I can be back to type in 3-4 days at max. Correct? any other update or suggestions? Thanks.

  • Zafar,
    I did not try any steroid injections or anything like that. I really didn’t have very much pain at all; there was nothing that really bothered me day-to-day. I was just worried about the long-term effect of my tendons snapping over the bone spur. (Also I didn’t like how it looked.) I certainly cannot offer you any assurances on when you’ll be back to work!! All I can tell you is my experience but I think everyone heals differently. (And I think different procedures may be required surgically depending on how the boss is situated).

    Liza,

    Eeep. I guess I have had a different experience than you. Most of the swelling was gone from hand within about a month of the surgery. I mean there is still some lingering inflammation in my fingers, but it’s not really noticeable unless you compare it with my left hand. Here are some photos I took today:

    hand my right hand four months after carpal boss surgeryScar close-up

    Nothing has really changed from my last update. Day-to-day my hand is fine … but it was fine before the surgery, too; I did not have the problems some people have described here. During yoga, holding “planks” and chatarungas, it is still not as good as it was pre-surgery, but firm handshakes are no longer a wincing matter. Occasionally I will bump my knuckles and they are still ever-so-slightly tender.

  • ann

    hello, i started feeling pain in my hand like a month ago, after seeing 3 doctors, the last one said i have carpal boss, but he told me that it doesnt require surgery, just therapy… i have a question tho, i just thought about it… i thought i had a cyst in my hand for a few years, but around the time the pain started, the “cyst” was gone, do u think it has some kind of conection?

  • Hi Ann, sorry, I’m not a doctor. I have no idea.

  • Jane Feasby

    Hi, glad to read your surgery was successful, I had carpo-metacarpal bossing excision surgery in 1991, and now I am about to have the whole thing all over again…the bossing can grow back.
    This time its not a full anaesthetic and 4 days in hospital, its day-case and ‘only’ a block anaesthetic. (the UK NHS tries to keep costs down)
    I am not looking forward to being awake during the procedure! But the benefit is that I don’t have to eat revolting hospital food!?!

  • Jane: Four days in the hospital! Yikes! I was in and out of the NYC ambulatory center where I had my surgery in about six hours. Regarding sedation, actually I can access my insurance claim online: it looks like they gave me fentanyl citrate, a painkiller, and a sedative/memory block called midazolam (“midazolam hcl per 1mg/49mx,” whatever that means). These are very cheap drugs! It looks like my insurance company paid, um, 37 cents for the midazolam and $1.03 for the fentanyl citrate?? Seriously. (Although the entire operation cost my insurance company a bit more: $9,980.64).

    Anyway so I guess what they gave me is considered a local anesthetic, it was injected into my wrist area. I don’t THINK I was awake for the surgery, but I can’t really say for sure. I guess midazolam can induce something called “twilight anesthesia” where the patient is groggy but still able to follow commands … and forgets about it afterward. I just remember talking with the anesthesiologist on the operating table… and then there’s a gap. I woke up in the recovery room to my surgeon telling me the operation was a success.

    So anyway try not to anticipate, I’m sure it won’t be as bad as you imagine. Sorry to hear this is your second time having the operation! Jeez! My surgeon told me he thought there was a 99 percent chance mine would not grow back, but I imagine that depends on what caused yours in the first place.

  • Jane Feasby

    Hi Derek
    perhaps you will be lucky, not like me! But it has been 20 years.
    My carpel bossing is a familial genetic condition. My father, cousin and daughter all have them too, only on the right hand, and yes, we are all right handed.
    I suppose my worry is that last time I was 30 and now I’m zooming (so it seems) towards 51 and I have had rheumatoid arthritis for the last 10 years, which started in my right hand…..(now its everywhere, my 14 yr old son seems to think its even got to my sense of humour),so my recovery is going to be more difficult.
    I have had surgery under local before, I was fully awake for that (including the terrible music and jokes in the operating theatre), but it was ‘only’ a resection of a large abdominal scar, with 11 injections of local anaesthetic.
    Here in the UK we get NHS treatment, so I have no idea what drugs etc will be used.
    I’ll let you know, although I suspect I will be typing with one hand for a while afterwards, last time I was painting a ceiling 7 days after coming out of hospital.
    My pre-op check is in a weeks time, with the operation the week after.
    Rgds Jane.

  • Myra

    I had carpal bossing surgery in January; also on my dominant right hand. I had surgery in the evening so staid overnight. I wanted to be awake, so they did an axillary block. Offered Versed, but I declined. Pain post surgery was not bad at all. I’ve had two PT appointments and those hurt more than recovering from surgery. Just switched therapists. I go back to work tomorrow; have been off for 6 weeks. Because I am in school I needed to type–bought voice recognition software. It is awesome and is saving my hands!. Thanks for all of the info. given.

  • Myra

    Hey Ann, I did read somewhere that some people do get cysts before they develop bossing.

  • Hi Jane, just to clarify, I didn’t know what drugs I was going to get either. They didn’t tell me but I could see it on my insurance form. Versed (what Myra talks about) is actually the brand name of midazolam (or so Google tells me) … I wasn’t really given an choice about it although in retrospect I could have been more assertive. Not sure if I would have wanted to have been awake for it or not.

  • Liza

    Thanks for posting your pics, derek. I think I must be one of the “regrow” cases–the hand I had surgery on is now significantly worse than the left (which the surgeon had commented looked the worse of the 2, but since my right hand was the one that used to swell, I chose to “fix” it first). I guess I will make an appointment. Congrats on such a smooth back hand–and I don’t mean tennis! For others considering this, I would vote for the steroid injection. I would undo this solution if I could.

  • Jane Feasby

    Hi Derek, just had my pre-op check today (Tue 6th March 2012).
    It’s going to be bone excision and a metal plate will be screwed in to immobilise the bones (it is supposed to reduce the chance of re-occurrence, the bones moving against one another are thought to be the stimulus for re-growth of the bossing).
    This time it’s a regional anaesthetic (whole arm) with sedation, I am so glad there will be sedation.
    Operation on Monday!
    Rgds Jane

  • Jane Feasby

    I had the op yesterday(Mon 12th March), had to be at the hospital for 7.30am and then waited until 2pm to go into surgery, got home about 5.30pm. My friend, who took me to the hospital, stayed all day and took me home, then took my dog to stay with her.
    The parking cost £8.50!
    Block anaesthetic into shoulder, plus 3 injections of local, then 3 more injections of local because of the pain from the tourniquet. The sedative (two doses) just made me relax…which was good because I could see what the surgeons were doing reflected in the theatre lights! The sounds of the chisel(bone removal?)and the drill (a metal plate has been screwed into the bone) were horrible.
    Codine, paracetamol and ibuprofen for pain relief.
    Now the biggest problem is trying to wash with only one hand…and my 14 year old son’s cooking.

  • Liza

    Derek, you still doing well? Jane, I will be curious to hear how that metal plate works out! My PT people are dismayed at my poor outcome & suggest I go back to the surgeon for an x ray in April if I’m still having pain. The solution continues to be far worse than the problem; Myra, how are you doing? Maybe I just overused my hand too soon–the surgeon did not give me any restrictions, so who knew?

  • Yeah. I feel like I am getting better slowly and slowly. It really only bothers me holding plank and a few other similar yoga poses. I am hopeful it is still healing and maybe by summer I will be 100%.

  • Michellle

    Thank you so much for sharing your experience….I have an appointment with a hand surgeon in 2 weeks. I’m a critical care nurse, and I had never heard of this before visiting an orthopedic. The splinting and resting hasn’t worked, so I’m gonna bite the bullet, the pain and mobility are quite bothersome.

  • nichole

    i have the same thing i was debating getting it checked out. like you i’ve had this annoying bump on my right hand for years, after some drs in the er nicked an iv they were trying to put in my hand. i wasn’t born with it i guess but eh, its there now.

    would you say the surgery was worth it? i’ve been debating having someone look at it but i’m doing it mostly for a cosmetic reason. right now my hand works, i have no pain, etc, it doesn’t bother me but i hate the look of it and i would like it gone. however, i dont want to do it if that means months of not being able to use my hand. lol. was the recovery hard, and do you know if the docs told you about any possiblity if not being able to do things after the surgery. i play trumpet and the right hand is the hand used for depressing the valves, i’d be mad if i couldn’t play anymore…

  • Gordon

    I will begin by saying I had a bad reaction to surgery but must stress that I was operated under a misdiagnosis and this effectively caused all probs. Had I been diagnosed with carpal boss initially the op would have been a success. In my time no-one knew about carpal boss. My reaction is NOT common.I

    Nineteen years ago, at the age of 15, I presented with a lump on the back of my right hand My GP misdiagnosed it as a hard ganglion. He referred me to a local surgeon who, after one consultation, diagnosed it as a hard cist and arranged for me to have surgery. After surgery he said it was not a cist but did not know what it was. In the proceeding weeks, in the coming months the pain persisted. My surgeon was unsympathetic and did not agree to meet again. The lump grew back. I then was seen by another hand specialist who diagnosed carpal boss. He said the first surgery caused my current probs. He said that as I had not reacted well to surgery he would be reluctant to operate. I didn’t want more surgery. He did take a bone scan and a year later another. We compared the two and the activity was getting worse. As was my pain. I gave up the flute and turned down music degree courses. When I was 17 the pain was getting much worse, and so another doctor. He took a tomogram which took detailed sliced pictures millimetre by millimetre and he was amazed by the shape of my bone. There is now a bridge going from my metacarpal index finger across to a bone in my wrist. He operated. This was not a total success but it did halve the pain I was in, which I was very happy about.As a result, I have had chronic pain for over 15 years. I am now 34. I feel this will stay with me. It has always been the case that I could physically do everything but everything hurt. The pain is there every day to different extents. These are only a few examples.I am wondering about arthritis now.

  • Nichole,

    I don’t regret getting the surgery, but it’s hard to know whether it was “worth it” because I can’t really say what would have happened if I hadn’t gotten it done. Like would it have gotten worse, or stayed the same? It’s hard to tell.

    If you got the lump from a doctor nicking your hand, are you sure it’s not a ganglion cyst? A carpal boss is bone, a ganglion cyst is fluid/tissue.

    I feel like I answered your question about the recovery in my post. Doctor did not say anything about not being able to do things after I recovered.

  • Gordon

    Nichole, I agree it prob is not carpal boss. If it is a ganglian and there is no pain and it does not affect you physically often docs recommend that you leave ganglians alone. Invasive and unnecessary surgery is just not worth it. As a musician, grade 8 on flute, I got accepted into several third level music degree courses. I have had to give up music and the hopes of a career in music. That has broken my heart. Seeing so many of my friends who have careers in music is so hard. You mention that the only reason to operate is for cosmetic reasons. For me personally, this is not worth the risk. If it aint broke, don’t fix it.A ganglian or cist will always be just that, it will never develop into something worse. These are common inthe wrist especially in women. I have a large cist in my wrist a small cist in the back of my neck and another on the back of my leg. They do not worry me and I have been advised and with a second opinion not to mess with them. But it is your decision.

  • Marco

    Greetings to all!

    I won’t bore everyone with intricate details, but I had a carpal boss excised back in 2008. Surgery itself went absolutely fine, but I’ve had problems since, so I’m due to have another operation (fusion of one of the carpometacarpal joints) next month. If anyone is interested in more info, just post on here and I’ll be happy to share! After 4 years of dealing with it and a fair bit of research, I probably know more than most lay-people! Especially relevant for the couple of you who mentioned you were tennis players – I played tennis competitively (the reason for the 1st operation) which is why it’s been particularly frustrating.

    Also, in case anyone’s interested, this articlecould be useful. I say ‘could’ because I haven’t yet read it. Costs $32 I think, unless you’re better googlers than I am and can find it for free.

  • Gordon

    Marco, I would be keen to hear more of your story.

  • Marco

    Hi Gordon (and others interested). A bit long-winded, sorry! Feel free to ask any questions, and if anyone wants to email me directly, no probs either.

    Back in summer 2008, I started having considerable pain playing tennis, so much so that I couldn’t continue. Carpal boss was identified through MRI, and I was operated (general anaesthetic) on at the Lister Hospital in London. The operation was fine, I spent the usual 3 or so weeks in a cast, then shifted to the removable splint and began therapy.

    I’d estimate that after 6 or 7 months, I was in pretty good shape, but this of course is subjective. I could carry out every day tasks absolutely fine, there wasn’t any pain, it just occasionally felt a little uncomfortable/stiff. For most people, this is probably fine, but given the reason I had the op in the first place was to play tennis, it wasn’t good enough for me, so I kept going. I’d say that after 12-15 months it was at its “peak” – I could happily play tennis pain free, do press-ups, basically any weight-bearing, wrist–intensive exercise. It was still a bit stiff at times, but I could live with it. Not perfect, but good enough.

    But the discomfort grew, so I went back to the surgeon who recommended a steroid injection. This worked for a while (maybe 6 months), but gradually the symptoms returned, so I had a 2nd injection, with the same result – temporary relief before return of discomfort. Again, perfectly fine for day-to-day activities, but not tennis. It started to get a little worse again at the back end of last year.

    I went to see a different specialist, who recommended another MRI plus SPECT-CT scan. Before the scan, I went skiing and came back in much more pain, and I knew I had a real problem. The scan results clearly show a loss of carpometacarpal (CMC) joint space between the 2nd metacarpal (index finger) and the trapezoid carpal bone, with mild, but not drastic, loss of joint space elsewhere. I’ve had a 2nd opinion from a well known wrist surgeon and the agreement is that I need a fusion of that joint. It’s not a difficult procedure, but very rare.

    More importantly, we don’t know the cause – is it indication of general arthritis (both surgeons seemed to think not – and I’m only 30), an unintended knock-on effect from carpal boss excision, wear and tear from years of tennis (I suspect not – there was no indication of loss of joint space in previous scans when I was playing a lot more than did after the first surgery), or just bad luck?

    There’s quite a lot of info on carpal bosses online, but the procedure itself isn’t as common as you might think. Most articles say results are generally good, a few say that excision isn’t necessarily enough and can lead to subsequent problems. But in most cases the sample sizes aren’t that big, and are spaced over a number of years, so it’s hard to get a real feel for it. Both of the specialists I’ve been to recently agreed that excision was the right course of action given MRI results and symptoms, but whereas one said he wasn’t aware of any real evidence to suggest it wasn’t always a good idea, the other (more experienced) said that he tried to avoid it if he could.

    If it’s purely for cosmetic reasons and it’s not giving you any discomfort, I would strongly urge you to think carefully about whether it’s the right course of action. Mine was pretty subtle, so if it hadn’t been for sporting requirements, I wouldn’t have considered surgery. Bosses can grow back, although this is rare. As it stands, I’m booked in for surgery in early May. Even if the fusion surgery goes well, I’ve got no idea whether I will have a different problem again 2 years down the line – I’ve learnt that the wrist is an incredibly complex, intricate piece of machinery!

    I’m not going to him because I’m in London, but for what it’s worth Professor John Stanley of Manchester/Lancashire seems to have an excellent reputation in the world of wrist surgery in the UK.

  • Christina

    My name is Christina and I was diagnosed with a carpal boss a little over two years ago. I received a cortisone shot when I was first diagnosed and it took the pain away for about a year. I went back to my doctor and received a second shot about a month ago and the pain is already back. I was wondering if you had first received any other treatment prior to the surgery? I’m trying to find out if surgery is the next step.
    O and thank you for this blog because it is so hard to find any information on people who actually go through the treatments of carpal bossing.

  • Jane Feasby

    Hi everyone
    just an update, my cast was removed at 10 days after surgery (surgery was 12th March 2012) and a removable splint was made for me by the occupational therapists at the hospital. I have to wear it 24 hrs a day; only the top two joints of my fingers are free and the top joint of my thumb. By the time I see the consultant again I will have been wearing it for 8 weeks.
    I am unable to do anything functional with my hand and suspect it will take a long time for recovery of anything like normal function.
    The insertion of the plate into the bones is to immobilize and fuse them. My hand is still seriously swollen and gets quite painful.
    I am virtually housebound because I can not drive and because of my rheumatoid arthritis I cannot walk far.
    But to be fair, my son’s cooking is improving.

  • Christina — no other treatment before surgery. Read my blog post again; I really feel like I told the whole story there.

  • Marco

    Hi Jane,

    the only advice I can give you at this stage is to be absolutely militant about the exercises that the hand therapist gives you, particularly over the first couple of months. Don’t overdo it, of course, but make sure you don’t start cutting corners or putting it off “until later” – it’s surprisingly tempting, and easy, to do. Good luck!

  • jill

    I had this surgery last week. How long were your fingers swelled for? I am in a 1/2 cast wrapped in ace bandage and not allowed to remove it. My fingers are so swollen I cant even bend them. After your first visit were you put back into something to immobilize your wrist? How long were u out for? He said 4-6 weeks for me.

  • Jill — most of those questions I answered in my post. Honestly it’s been so long since I had the surgery (six months), you’re better off re-reading that me trying to remember the exact details of what happened. My fingers were swollen but never that badly.

  • Robert

    Is there anything that you are not able to do after having had hand surgery (and fully healed) due to the fact that you underwent this process? I am pretty sure that I have metacarpal bossing in my right hand. I generally only have issues with it when I practice the planche, a gymnastics position.

  • Robert, I’m still not sure if I’m fully healed. I hope my hand will still continue to get better. When I am in “push-up position,” or holding plank, my hand is still tender/sore. It’s mild and bearable, but I feel it. Also sometimes doing the bench press at the gym.

    Also one tip: I’ve been using a silicone scar gel I picked up at the drug store to try and reduce the scar on my hand (which you can see in the Feb. 18 comment). It seems to be working. (The brand I am using is Kelo-cote, although I don’t know that that is any better than other similar products).

  • Kam

    This has been so interesting to read! I am 7 days out since my carpal boss surgery. It wasn’t bad at all. I am in a hard cast up to my elbow. That has been the worst part. The itching in the cast is driving me crazy! It is suppose to come off in 2 days. I have experienced mild pain, but I went back to work after 4 days (including a weekend)and have been fine. I am anxious to see how it goes from here!

Leave a Reply

You can use these HTML tags

<a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <s> <strike> <strong>