Carpal Boss 726.91

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

• see Wrist 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

• Dorsal Wrist Ganglion

Carpal Boss Complications

• Cosmesis(scar)
• Infection
• Nerve injury
• Decreased motion
• Instability
• Complex Regional Pain Syndrome

Carpal Boss Follow-up Care

• Cast for 4-6 weeks to allow ligamentous healing.

Carpal Boss Review References

• Green's Operative Hand Surgery