Soft tissue lumps and tumours of the hand

A range of lumps can develop in the soft tissues of the hand, arising from structures such as joint and tendon linings, fat, nerves, blood vessels or skin. The great majority are benign (non-cancerous). Common examples include ganglion cysts, giant cell tumour of the tendon sheath, lipomas (fatty lumps), epidermal cysts, and less commonly nerve tumours such as schwannomas or vascular lesions.

Soft tissue lumps arise from different structures depending on their type. Ganglion cysts arise from a joint or tendon sheath lining. Giant cell tumour of the tendon sheath is the second most common hand lump after ganglion cysts. Lipomas are benign fatty lumps, and epidermal cysts arise from the skin. Less commonly, lumps can arise from nerves (schwannomas) or blood vessels (haemangiomas). Very rarely, a lump in the hand represents a malignant growth.

A lump that is small, stable and clearly benign on examination and imaging can often simply be observed rather than treated. It is worth being assessed for any new or enlarging lump, a lump that is painful or affecting movement, or any lump you are unsure about.

If a lump is removed surgically, a hand therapist can support your recovery of movement and function afterwards. For lumps that are being observed rather than treated, ongoing monitoring is generally managed by your hand surgeon.

Dr Tomlinson can examine the lump and, where needed, arrange imaging such as ultrasound, x-ray or MRI to help characterise it. Surgical excision is recommended if a lump is growing, symptomatic, affecting function, or if there is any uncertainty about the diagnosis, since removing it allows the tissue to be examined under the microscope to confirm what it is. Giant cell tumour of the tendon sheath, while benign, can recur after removal, and is usually excised carefully to reduce this risk.

At your appointment, Dr Tomlinson will examine the lump and discuss any imaging you have already had. Together you will discuss whether observation or removal, with pathology assessment of the tissue that has been removed, is appropriate for your situation. In some circumstances she will refer you for further imaging.

The great majority of soft tissue lumps in the hand are benign, and small, stable lumps can often simply be observed. However, any new or enlarging lump, or one that is painful or affecting movement, should be assessed, since removal with pathology assessment is the only way to confirm what a lump is with certainty.