Surgery for lumps and tumours of the hand

Various lumps can appear on the hand and wrist, most of them benign. Among the common ones are:

• ganglion cysts, fluid-filled lumps connected to a joint or to a tendon sheath, often on the back or front of the wrist;
• benign tendon sheath tumours, firm lumps, usually on the fingers;
• lipomas, soft collections of fatty tissue;
• skin or subcutaneous cysts.

Surgical treatment consists of removing the lump (excision). At Detalii Med in Baia Mare, the procedure is performed by Dr Marius Pruna and Dr Valeria Pruna.

The procedure is intended for patients with a lump of the hand or wrist that:

• causes pain, discomfort or difficulty with movement or gripping;
• presses on a nerve and causes numbness or tingling;
• is growing or changing in appearance;
• is bothersome cosmetically or functionally;
• is of uncertain nature and needs to be clarified.

Not every lump needs surgery. Some small ganglion cysts without symptoms can simply be monitored, with the decision made at the consultation.

Excision removes the lump and, with it, usually the symptoms it was causing, such as pressure or pain. Where necessary, the removed tissue is sent for histopathological examination, which establishes exactly what the lump is.

The procedure cannot always rule out recurrence. Ganglion cysts in particular carry a risk of recurrence even after correct excision, and some benign tendon sheath tumours may also come back. The operation leaves a scar, usually discreet, whose visibility depends on the area and on each patient’s healing.

At the consultation, the doctor examines the lump: its location, size, consistency, mobility, connection with tendons or joints and any effect on sensation or finger movement. When it appeared, how it has changed over time and the symptoms are discussed.

Imaging may sometimes be needed, for example an ultrasound scan, to clarify the content and extent of the lump. The doctor explains whether removal is indicated, how the procedure is carried out, the risk of recurrence and whether histopathological examination is recommended.

After the area has been disinfected and anaesthetised, the surgeon makes an incision over the lump, carefully separates it from nerves, blood vessels and tendons and removes it. For a ganglion cyst, the aim is also to remove the stalk connecting it to the joint or tendon sheath, to reduce the risk of recurrence.

The wound is closed with stitches and the hand is covered with a dressing, sometimes also a splint for a few days. The length of the procedure depends on the type and size of the lump. The patient usually goes home on the same day.

Most procedures are performed under local or regional anaesthesia, depending on the location and size of the lump. The patient should not feel pain during the operation, at most pressure. The type of anaesthesia is decided at the consultation.

After the procedure, the hand is kept raised for the first few days to limit swelling, and discomfort is usually controlled with the painkillers recommended by the doctor.

• the dressing is changed at the agreed intervals, and the wound should be kept clean and dry;
• stitches are removed, as a guide, after about 10–14 days;
• finger movement is resumed gradually, as instructed;
• effort with the hand is resumed depending on healing, usually after a few weeks.

The result of the histopathological examination, if one was carried out, is discussed at the follow-up appointment.

The risks are generally low, but they should be known:

• bleeding, haematoma or infection;
• temporary stiffness or swelling;
• tenderness at the scar;
• injury to a small nerve in the area, with numbness that is usually temporary and rarely persistent;
• recurrence of the lump, particularly with ganglion cysts;
• complex regional pain syndrome, a rare complication.

The doctor explains at the consultation the risks specific to the type of lump and its location.

The lump is gone immediately after excision, and compression symptoms usually improve over the following days or weeks. Wound healing takes, as a guide, a few weeks, and the scar matures over several months.

The histopathology result is usually available after a few weeks. If the lump reappears, the patient is advised to return for a check-up.

Most lumps of the hand and wrist are benign, but careful assessment is important to establish what they are and whether surgery is needed. Excision, usually under local or regional anaesthesia, removes the lump, and histopathological examination clarifies it where necessary. Ganglion cysts can recur. The plan is agreed at the consultation at Detalii Med.