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Carpal Boss M25.739 726.91

 

synonyms:

Carpal Boss ICD-10

  • M25.731 - Osteophyte, right wrist
  • M25.732 - Osteophyte, left wrist
  • M25.739 - Osteophyte, unspecified wrist
  • M25.741 - Osteophyte, right hand
  • M25.742 - Osteophyte, left hand
  • M25.749 - Osteophyte, unspecified hand

Carpal Boss ICD-9

  • 726.91(exostosis of unspecified site)
  • 733.20 (other disorders of bone and cartilage, cyst of bone (localized), unspecified

Carpal Boss Etiology / Epidemiology / Natural History

  • An osteoarthritic spur at the base of the second and/or third carpometacarpal joint.
  • More common in women. 2:1. Generally 3rd-4th decade.

Carpal Boss Anatomy

Carpal Boss Clinical Evaluation

  • Firm, bony, nonmobile, mass at the base of the CMC joint. More obvious when wrist is flexed.

Carpal Boss Xray / Diagnositc Tests

  • A/P, lateral and oblique xrays of the wrist. Mass is best visualized with the hand in 30°-40° of supination and 20° to 30° of ulnar deviation.

Carpal Boss Classification / Treatment

Carpal Boss Surgical Technique

  • CPT: 25130 
  • Supine, arm board, +/-antibiotics, turniquet, 3.5x loupe magnification
  • Transvers incision along Langer’s lines
  • Skin hooks for retraction, iris/tenotomy scissors
  • EDC, EIP tendons retracted ulnarward.
  • Circumferentially mobilize any associated ganglion. Identify pedicle, dissect to origin and excise ganglion.
  • Expose CMC osteophytes and excise with small osteotomes.
  • Palpate the area throught the skin to ensure adequate excision.
  • Irrigate wound
  • Sub-q closure, skin closure
  • 5cc 5% bupivicaine for post-op pain
  • Dorsal/palmar splint

Carpal Boss Associated Injuries / Differential Diagnosis

Carpal Boss Complications

  • Cosmesis(scar)
  • Infection
  • Nerve injury
  • Decreased motion
  • Instability
  • Complex Regional Pain Syndrome

Carpal Boss Follow-up Care

  • Cast for 4-6 weeks to allow ligamentous healing.

Carpal Boss Review References