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Lump removal – including removal of giant cell tumour
Lump removal addresses benign growths in the finger, hand, or wrist, including giant cell tumours of the tendon sheath, which are the second most common hand tumour after ganglion cysts. Surgical excision removes the lump and its surrounding tissue to relieve discomfort or restricted movement and reduce the chance of it returning.
At a glance
Anaesthetic
Local anaesthetic, sedation or general anaesthetic - depends on lump size and location
Where
Consulting rooms or The Avenue Hospital
Day case or overnight
Day case - home the same day
First post operative review
Approximately one week after surgery
Driving
Not until sensation has returned and movement and grip are comfortable
Post Operative Hand Therapy
May be recommended depending on the lump's location and extent of surgery
Splinting
A bandage is usually all that is needed; splinting depends on lump location and size
Pain relief
Usually paracetamol and/or ibuprofen
Return to repetitive & heavy loading
Light activities within a few days; full use of the hand usually within 2-4 weeks
Surgical removal of a soft tissue lump in the hand, including giant cell tumour of the tendon sheath
This surgery removes a soft tissue lump from the hand or fingers. Giant cell tumour of the tendon sheath is the most common solid (non-cystic) lump of the hand after ganglions – a firm, slow-growing, benign lump that arises from the lining of a tendon sheath or joint, most often on the fingers.
Who is this procedure for?
- People with a lump that is enlarging, painful, or interfering with hand function
- People whose lump needs to be removed for diagnosis, to confirm it is benign and rule out other causes
- People whose lump is affecting nearby structures, such as pressing on a nerve or restricting joint movement
- People who want the lump removed for cosmetic or functional reasons even if the diagnosis is already reasonably clear
What does the surgery involve?
Surgery involves an incision over the lump, carefully dissecting it away from surrounding nerves, blood vessels and tendons, and removing it completely, including its base or origin where identifiable. For giant cell tumour of the tendon sheath specifically, thorough removal reduces (but does not eliminate) the risk of recurrence, since these lumps can have multiple lobules that are not always obvious at the time of surgery. The removed tissue is sent for pathological examination to confirm the diagnosis.
Alternatives to surgery
Surgery is one option for a hand lump. Depending on your situation, the alternatives may include:
- Observation: appropriate if the lump is small, not growing, and not causing symptoms – though many lumps, including giant cell tumours, will slowly grow over time
- Imaging (ultrasound or MRI): can help characterise the lump before deciding on surgery, particularly if the diagnosis is uncertain
What happens if left untreated: most hand lumps, including giant cell tumours, are benign and slow-growing, and can safely be observed if not causing problems; however, they can gradually enlarge and, if close to a joint or nerve, cause increasing symptoms over time.
Dr Tomlinson will discuss which options suit your specific lump at your consultation.
Frequently Asked Questions
Where will my surgery be done?
For this procedure the location depends on the size and location of the lump – discuss at consultation.
Why might I choose local anaesthetic rather than sedation or a general anaesthetic?
A procedure under local anaesthetic avoids the risks and recovery of sedation or a general anaesthetic. You don’t need to fast beforehand, you can eat and drink normally, you recover quickly, and you usually go home soon afterwards. For many people it’s also less expensive and more convenient. For some procedures, local anaesthetic alone is not an option – in that case Dr Tomlinson will advise you of this at your consultation.
How much time will I need to have away from work?
This depends on what your job involves and the lump’s location. Desk-based work can often resume within a day or two, although keeping the finger elevated is desirable to minimise swelling and to speed recovery. Manual work involving the affected area will need to be modified for a couple of weeks. Dr Tomlinson will give you advice tailored to your job at your consultation.
When will I be able to drive again?
Multiple things affect this: which hand was treated, whether you’re wearing a bandage, whether you can grip the wheel and respond safely in an emergency, whether you are driving for personal or commercial purposes, the nature of the vehicle you are driving, and your pain levels and medications. You must be safely in control of the vehicle for insurance purposes – you should be able to grip the steering wheel strongly with both hands and be able to take evasive action in an emergency before you get behind the wheel. As a guide: plan not to drive for one week after the procedure.
When can I do a full day of administrative or desk work?
Often from a couple of days after surgery, particularly with some temporary adjustments (see below). Keeping your hand elevated and taking regular breaks helps reduce swelling and discomfort in the early days. If you need to drive to work or carry or lift objects as part of your administrative work then alternate or half days may be a prudent measure when first returning to work.
What workplace modifications might help?
Depending on your job, helpful temporary modifications can include:
– Half days or alternate days to begin with
– No heavy lifting
– Lighter duties or being off tools
– More frequent breaks
– Using a headset instead of holding a phone
– Voice-to-text or dictation instead of typing
– Keeping the hand elevated at your workstation
– Avoiding repetitive gripping
– Help with carrying or moving items
– Moving temporarily to reception or phone duties if your role is normally manual
– Protecting the wound if your work exposes your hands to water or contamination (e.g. food handling, healthcare, wet trades)
We’re happy to provide a letter for your employer outlining recommended modifications.
I take a GLP-1 medication (such as Ozempic, Wegovy, Mounjaro or Trulicity) — how does this affect my procedure?
GLP-1 medications, used for diabetes or weight management, slow the emptying of the stomach. This can increase the risk of stomach contents being present during sedation or a general anaesthetic. In line with current ANZCA guidance, if you’re having sedation or a general anaesthetic you’ll be asked to follow a clear-fluid-only diet for 24 hours before your procedure, followed by the standard 6-hour fast. Please tell us and your anaesthetist that you take this medication — your anaesthetist will give you specific instructions. If your procedure is under local anaesthetic only, fasting is generally not required, but please still let us know.
How long will I need to wear a splint?
Splinting requirements depend on the lump’s location – lumps near a joint may need brief splinting for comfort, while others require only a simple bandage.
Will I need to see a hand therapist afterwards? May I see one if I'd like?
Hand therapy is not routinely needed for a straightforward lump excision, but may be recommended if the lump was closely related to a joint or tendon requiring more extensive dissection.
What pain medication will I need afterwards?
Usually simple pain relief – paracetamol and ibuprofen – is all that’s needed. Some procedures are more uncomfortable and you may need stronger pain relief. We can always prescribe stronger painkillers if you need them.
Risks & complications
General risks of hand surgery
- Bleeding and bruising; rarely, a collection of blood (haematoma) that may need draining
- Infection, which may require antibiotics or, rarely, further surgery
- Pain — usually temporary, occasionally persistent
- Swelling – common, and usually settles over weeks to months
- Scarring – scars are permanent and occasionally become thickened, raised or sensitive
- Allergic reaction to the local anaesthetic, antiseptic, dressings, tape or suture material
- Delayed or problematic wound healing
- Stiffness or reduced movement in the fingers, hand or wrist
- Injury to nerves, causing numbness, altered sensation or, rarely, a painful neuroma
- Injury to blood vessels (arteries)
- Injury to tendons
- Injury to bone (fracture)
- Failure to fully relieve your symptoms, or symptoms returning over time (recurrence)
- Complex regional pain syndrome (CRPS) – an uncommon but significant condition causing ongoing pain, stiffness and swelling
- Cold intolerance – the hand becoming more sensitive to cold, usually improving with time
- The need for further surgery
- Blood clots in the leg or lung (DVT/PE) – uncommon in hand surgery, with a slightly higher risk after a general anaesthetic or prolonged immobilisation
Specific risks of this surgery
- Recurrence of the lump
- Injury to a digital nerve or artery during removal, since these tumours often surround or sit close to them
- Temporary or persistent loss of sensation in the finger
- Stiffness of the finger
Anaesthetic
If you are having sedation or a general anaesthetic for this procedure, your anaesthetist will discuss the specific risks of anaesthesia with you separately.
Recovery & rehabilitation
First 48 hours
Keep your hand elevated for 48 hours to reduce bleeding and post-operative swelling. Local anaesthetic lasts 6–24 hours (occasionally 1–3 days); your hand will have numb areas during this time.
First week
Keep the dressing dry and intact until your post-operative review. You may use your hand for light activities, but listen to your hand and avoid anything that causes pain, such as lifting or gripping. Scar sensitivity and discomfort with lifting and gripping are expected in the first few weeks. Listen to your hand and do not perform activities that cause discomfort. You should find that your hand function is better each day.
Second week
The wound is usually settling well. Movement of the hand and fingers is encouraged unless otherwise advised, and any numbness or tenderness around the scar gradually improves.
6 weeks
Full grip strength may take several months to return, and deep-pressure tenderness over the wound can persist for some months. The scar will feel tight and firm. Massage assists with improving scar mobility and minimising scar firmness.
3 months
The scar firmness will start to resolve after 3 months, and will take up to 12 months to settle.
Long term
Most people return to full activities within 2-4 weeks. Pathology results confirming the diagnosis are typically available within one to two weeks and will be discussed with you at your follow-up appointment.
Want to know more about Lump Removal (Including Giant Cell Tumour of the Tendon Sheath)?
Contact us to schedule an appointment with Dr Tomlinson.
Fees and costs
You will receive a written financial quotation after your consultation, once your operation and any third-party requirements are confirmed. See our Fees and informed financial consent page for how our fees work, what your quotation includes, and the resources available to you.