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Tumors of the Hand and Wrist

ganglion of the tendon sheath

Giant cell tumor xray

Giant cell tumor xray

Giant cell tumor clinic photo

Volar wrist ganglion photo

Chondrosarcoma  
Enchondroma Glomus Tumor
Epidermal Inclusion Cyst Osteosarcoma
Ganglion Sarcoma
Giant Cell Tumor of Bone Synovial cell sarcoma
Giant Cell Tumor of the Tendon Shealth  

Giant Cell Tumor of the Tendon Shealth

  • Generally 3-5 decades
  • DIP joint most common
  • Firm, tender nodule
  • Treatment: marginal surgical excision. High recurrence rate.

Giant Cell Tumor of Bone

  • Affects epiphysis: distal radius, metacarpal head.
  • Rare instances of metastases.
  • High recurrence rate
  • Xray: expansile, lytic lesion with indistinct borders.
  • Treatment: curretage with bone grafting. Consider polymethacrylate cementation, cryosurgery, cauterization. May require en bloc resection +/- allograft reconstruction / wrist fusion.

Glomus Tumor

  • Generally occurs in subungal location.
  • Generally c/o hypersensitivity of temperature and exquisite pinpoint tenderness with pain that radiates proximally
  • Treatment: Excision. High recurrence rate.

Epidermal Inclusion Cyst

  • Generally result from penetrating trauma, trapping epithelial cells in the subcutaneous tissues.
  • Firm, mobile, painless.
  • Treatment: margninal excision.

Enchondroma of the Hand  
  • Most common benign bone tumor affecting the hand.
  • May have thinned cortices which fracture with minor trauma.
  • Pathologic fracture of enchondroma of the hand generally treated with immobilization to allow the fracture to heal followed by curettage with bone.  
References
  • Jacobson ME, Ruff ME. Solitary enchondroma of the phalanx. J Hand Surg Am. 2011 Nov;36(11):1845-7.  
  • Sassoon AA, Fitz-Gibbon PD, Harmsen WS, Moran SL. Enchondromas of the hand: factors affecting recurrence, healing, motion, and malignant transformation. J Hand Surg Am. 2012 Jun;37(6):1229-34.