Hard and Sore Bump at Wrist-Hand Junction
The most likely diagnosis is a ganglion cyst, which is the most common benign mass in the hand and wrist, typically presenting as a firm, localized bump that can be tender. 1
Most Probable Diagnosis: Ganglion Cyst
A ganglion cyst is the leading consideration for a hard, sore bump at the wrist-hand junction, particularly when unilateral. These benign lesions most frequently arise adjacent to joints and tendons in this exact location. 1
Key Clinical Features Supporting This Diagnosis:
- Location: Ganglions commonly occur at the wrist-hand junction where you describe the bump 1
- Consistency: They present as firm or hard masses that can be tender or painful 1, 2
- Unilateral presentation: Single-sided occurrence is typical 1
Recommended Diagnostic Approach
Start with plain radiographs (X-rays) in three views: posteroanterior, lateral, and oblique. This is the appropriate initial imaging study and may be sufficient to establish the diagnosis or rule out other causes like fractures, arthritis, or soft tissue calcification. 3
If Radiographs Are Normal or Inconclusive:
Proceed with ultrasound as the next imaging study. Ultrasound is particularly effective for evaluating superficial masses at the wrist-hand junction and can definitively confirm whether the bump is cystic (ganglion) versus solid. 3, 2
- Ultrasound can assess the cyst's precise location, size, and relationship to adjacent structures 2
- It can determine if the mass is causing nerve compression (such as carpal tunnel syndrome from a volar ganglion) 4
- It's cost-effective and readily available for typical cyst evaluation 2
MRI without IV contrast is an alternative if ultrasound is unavailable or if atypical features are present, such as neurologic symptoms or concern for other soft tissue pathology. 3, 2
Alternative Diagnoses to Consider
Calcium Deposition Disease
If the bump is extremely hard and associated with acute, severe inflammation, consider calcific periarthritis. This presents with focal, painful calcium deposits but is less common than ganglion cysts. 5
Carpal Boss
A bony prominence at the base of the second or third metacarpal can present as a hard bump, but this would be visible on radiographs. 3
Occult Fracture or Bone Pathology
Though less likely with a palpable bump, bone scan can detect occult fractures or metabolically active bone abnormalities if plain films are negative and symptoms persist. 3
Critical Clinical Pitfalls to Avoid
- Do not assume all wrist bumps are benign without imaging confirmation. Always obtain radiographs first to rule out bony pathology. 3
- If the bump is associated with numbness, tingling, or weakness, consider that ganglion cysts can compress the median nerve and cause carpal tunnel syndrome, requiring more urgent evaluation. 4
- Do not order MRI before obtaining plain radiographs, as this violates standard imaging algorithms and may miss important bony findings. 6
Management Implications
For Confirmed Ganglion Cyst:
- Observation is acceptable in most cases, particularly if symptoms are mild 1
- Aspiration can be attempted but has a recurrence rate greater than 50% for most wrist locations 1
- Surgical excision is definitive treatment with only 5% recurrence when the cyst stalk and small portion of joint capsule are completely removed 1