What is the lump in the palm of my hand?

Lumps and bumps are common in the palm of the hand. Most hand lumps are not cancerous, but patients should seek evaluation by a trained physician to make the diagnosis. Below are the most common causes of lumps in the palm.

Ganglion Cyst

The most common cause of a lump in the hand is a ganglion cyst. These are fluid filled sacs that come from a finger joint or tendon fluid in the hand.They often feel round and rubbery. They often fluctuate in size. In other words, the cyst can be big one day and then become smaller in a few days. Occasionally, the cyst will go away on its own. 

If the cyst is painful, it can be drained with a needle by a doctor or removed by a surgeon. Drainage of the cyst with a needle is a simple treatment, but the cyst often comes back. After surgery, the chance of recurrence is 5-10%. If the cyst is not painful or bothersome, it does not require treatment. Ganglion cysts are not cancerous. 

Dupuytren’s Nodules

Another very common cause for a lump in the palm is due to Dupuytren’s contracture. These lumps are called Dupuytren’s nodules. Because of their location and appearance, they are often confused with ganglion cysts. Dupuytren’s nodules are made up of abnormal scar tissue or collagen. The nodules are somewhat firm and may cause the nearby skin to dimple. 

Dupuytren’s is more common in males of Caucasian ethnicity. Sometimes it is called Viking’s disease because it is more prevalent in Scandinavian, Scotch-Irish, and North European populations where the Vikings lived. In many cases the condition occurs in both hands and it often runs in families. Doctors do not know the exact cause of Dupuytren’s disease, but there is thought to be a genetic predisposition.  

It is hard to predict if the nodule will cause functional problems with the hand in the future. One long-term study from Scandinavia showed that only 35% of patients with a nodule will develop a joint contracture in the finger. Another study showed that 10% of the palm nodules went away over time. In any case, patients should be evaluated by a trained physician to make the diagnosis and discuss treatment options.

Most of the time the nodules are not painful. Occasionally, the nodules are tender to the touch, and these can be treated with steroid injections in some cases. If a joint contracture develops in the finger, a hand surgeon can be helpful to improve finger range of motion and hand function. Surgical and non-surgical treatments are available to help the symptoms, but there is no known cure for Dupuytren’s disease. 

Tenosynovial Giant Cell Tumors

Giant cell tumors are common soft tissue tumors in the hand. These are typically firm and slow growing. They can be painful if they press on a nerve or grow to a large size. Although they have a scary name, these tumors are not cancerous. They are named after the appearance of the abnormal tissue under the microscope. Usually these are treated by a surgeon with excision in the operating room. There is a 20-30% chance that the giant cell tumor comes back after surgery. The cause of these tumors is not known. 

Epidermal Inclusion Cysts

Epidermal inclusion cysts are common following trauma or lacerations to the skin of the hand. These are usually slow growing and occasionally tender. These cysts are made of up keratin material shed from skin cells within the lesion. This is a thick, white-yellow, cheese-like substance. Surgery is usually recommended for epidermal inclusion cysts when they are causing symptoms. Recurrence of the cyst after surgery is very low. 

There are several other causes for lumps in the palm including: lipomas, nerve tumors, neuromas, blood vessel tumors, and cancers. Please seek evaluation with a trained physician to make the diagnosis. Hand surgeons are experts in the diagnosis and treatment of hand lumps, bumps, cysts, and tumors.