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Have you ever heard of a problem in the wrist called carpal boss? My son has this and it's very painful. What can be done about it?

Carpal boss was first reported in the literature back in the early 1930s. It refers to a condition of wrist pain caused by a bony protuberance or bump. It's located at the base of the index and middle fingers near the back of the wrist.

It's not a very common problem, so there isn't a lot of information about the best way to treat this condition. Some studies report that just surgically removing the extra bone isn't the answer. The problem can come right back.

Further studies found that cutting the dorsal ligament between the base of the finger and the wrist during the procedure caused joint instability. Now, surgeons are careful to remove the bone without disrupting the soft tissues whenever possible.

But before surgery is ever attempted, a long trial of conservative care is advised. Nonsteroidal antiinflammatory drugs (NSAIDs) may be prescribed. Hand therapy with a physical or occupational therapist may be helpful. Splinting at night can stabilize and protect the wrist, thereby reducing symptoms.

When surgery is necessary, more than one operation may be needed. If removing the bone results in wrist joint instability, then a fusion is the next step. Bone scans can be used to predict the need for this type of surgery. Relief from painful symptoms occurs in six out of seven patients who have a fusion.

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