Carpal boss is one of the most common benign bony tumors of the hand and wrist — a bony spur that develops due to osteoarthritis at the base of the second or third metacarpal joints. The condition presents as a firm, fixed lump on the back of the hand near the wrist that becomes more prominent when the patient makes a fist. Because it sits in the same general area as a dorsal ganglion cyst, carpal boss is frequently confused with that more common soft tissue lump — and the two conditions can also occur together. Accurate diagnosis matters because the treatment approaches differ. At Los Angeles Plastic Surgery in Beverly Hills, Dr. John Anastasatos diagnoses and surgically removes carpal boss with the depth of hand surgical training this anatomically intricate procedure specifically rewards.

Dr. Anastasatos performs carpal boss surgery with the most directly relevant academic credential possible: he completed a fellowship in Hand and Upper Extremity Surgery and Microsurgery at the University of Alabama at Birmingham — formal subspecialty training in the deep anatomy and surgical technique of the hand that few cosmetic plastic surgeons possess. He has presented at Cedars-Sinai Medical Center Grand Rounds on advanced surgical techniques — teaching credentials at one of the leading medical institutions in Southern California. With over two decades of facial and hand surgical expertise in Beverly Hills since 2007, he is board certified by the American Board of Plastic Surgery, a Fellow of the American College of Surgeons (FACS), a member of the American Society of Plastic Surgeons (ASPS) and American Society for Aesthetic Plastic Surgery (ASAPS), and named by The Luxe Insider as one of the Top 10 Plastic Surgeons in the World.

Diagnosing Carpal Boss

Proper medical examination is essential because carpal boss can be confused with a dorsal ganglion cyst — and the two conditions sometimes occur simultaneously. Imaging plays a key role in accurate diagnosis:

• X-rays with special carpal boss views — the standard imaging study, requested specifically from the radiology department to optimally visualize the bony prominence
• Physical examination — the lump’s characteristic firmness, fixed position, and increased prominence with fist-making distinguish it from softer ganglion cysts
• Evaluation for associated ganglion cyst — when both conditions coexist, the surgical plan must address both

Some patients with carpal boss are asymptomatic and may not require surgery. Others experience pain, inflammation, and a visible deformity that becomes more prominent with hand use — and many elect surgical removal for cosmetic reasons even when symptoms are mild.

Surgical Treatment of Carpal Boss

Carpal boss treatment is surgical. The procedure is approached through a transverse incision over the bony prominence, and the technique follows a specific sequence:

• Skin and subcutaneous tissue incised to expose the deeper structures
• Extensor tendons retracted to provide access to the bony prominence
• Capsule of the boss incised to expose the underlying osteoarthritic bone
• Small rongeurs and osteotomes used to carefully chisel away the osteoarthritic osteophytes
• All opposing osteoarthritic surfaces removed so that healthy cartilage covers the joint surfaces
• Joint space inspected between the carpal and metacarpal bones — typically the second and third metacarpals
• Associated ganglion cyst removed when present, including the cyst wall, contents, and any stalk arising from the joint

The approach is meticulous because incomplete removal can lead to recurrence. Hand surgery experience matters meaningfully for the precise removal of all osteoarthritic surfaces.

Schedule a Carpal Boss Consultation in Beverly Hills

Dr. Anastasatos welcomes patients to the Beverly Hills office at 436 North Bedford Drive, Suite 202, Beverly Hills, CA 90210, for a private consultation evaluating your specific anatomy and outlining the appropriate treatment approach. Contact Los Angeles Plastic Surgery to schedule a carpal boss consultation with Dr. Anastasatos.