Carpal Boss
synonyms:
Carpal Boss ICD-9
- 726.91(exostosis of unspecified site)
- 733.20 (other disorders of bone and cartilage, cyst of bone (localized), unspecified
Carpal Boss Etiology / Epidemiology / Natural History
- An osteoarthritic spur at the base of the second and/or third carpometacarpal joint.
- More common in women. 2:1. Generally 3rd-4th decade.
Carpal Boss Anatomy
Carpal Boss Clinical Evaluation
- Firm, bony, nonmobile, mass at the base of the CMC joint. More obvious when wrist is flexed.
Carpal Boss Xray / Diagnositc Tests
- A/P, lateral and oblique xrays of the wrist. Mass is best visualized with the hand in 30°-40° of supination and 20° to 30° of ulnar deviation.
Carpal Boss Classification / Treatment
Carpal Boss Surgical Technique
- CPT: 25130 (excision or curettage of bone cyst or benign tumor of carpal bones)
- Carpal boss case card.
- Supine, arm board, +/-antibiotics, turniquet, 3.5x loupe magnification
- Transvers incision along Langer’s lines
- Skin hooks for retraction, iris/tenotomy scissors
- EDC, EIP tendons retracted ulnarward.
- Circumferentially mobilize any associated ganglion. Identify pedicle, dissect to origin and excise ganglion.
- Expose CMC osteophytes and excise with small osteotomes.
- Palpate the area throught the skin to ensure adequate excision.
- Irrigate wound
- Sub-q closure, skin closure
- 5cc 5% bupivicaine for post-op pain
- Dorsal/palmar splint
Carpal Boss Associated Injuries / Differential Diagnosis
Carpal Boss Complications
Carpal Boss Follow-up Care
- Cast for 4-6 weeks to allow ligamentous healing.
Carpal Boss Review References
- Green's Operative Hand Surgery
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