Intended for healthcare professionals

Endgames Case Review

A lump in the hand

BMJ 2021; 373 doi: (Published 23 June 2021) Cite this as: BMJ 2021;373:n1447
  1. Lydia Robb, core surgical trainee1,
  2. Tim Buick, core surgical trainee1,
  3. Philippa A Rust, consultant Hand and Wrist Surgeon2
  1. 1Department of Plastic and Reconstructive Surgery, NHS Lothian, St John’s Hospital Livingston, West Lothian, UK
  2. 2Hooper Hand Unit, NHS Lothian, St John’s Hospital Livingston, West Lothian, UK
  1. Correspondence to: L Robb lydia.robb{at}

A man in his late 40s presented to his general practitioner with a history of skin changes and two lumps in his left hand, which had been present for several years. He thought the symptoms were from repeated trauma after carrying heavy buckets as part of his job. The nodular lumps had recently increased in size. In the months before referral, the patient began to experience a severe burning sensation in the nodules in his hand, which interrupted his sleep.

Examination of the hand revealed an area of skin tethering with a palpable thickening deep to it in the palm over the hypothenar eminence (fig 1, fig 2). Two small erythematous lumps were found, one proximal to the main lesion at the wrist crease and another on the ulnar border of the hypothenar eminence. In addition, the patient had numbness over the ulnar border of the hand, little finger, and half of the ring finger, and weakness in the intrinsic muscles of the hand (palmar and dorsal interossei). He …

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