Lump on Finger or Hand: What It Could Be

What a hand or finger lump usually is

The hand is packed with joints, tendons and their sheaths, so lumps here usually come from those structures. More than half of all hand lumps are ganglion cysts. Most of the rest are other benign growths: cysts from the skin, fatty lumps, bony outgrowths from arthritis and small benign tumors that grow from tendon sheaths.

Where the lump sits is the single most useful clue.

Common causes of a lump on the finger or hand

Ganglion cyst

A ganglion cyst is a sac of thick, jelly-like fluid that bulges out from a joint or tendon sheath. It is most common in people aged 15 to 40 and in women. It feels smooth and rubbery, sometimes surprisingly hard when the fluid is under pressure. It may grow with activity and shrink with rest, and up to half disappear without treatment within a few years. Shining a flashlight through it often makes it glow (transillumination), which helps separate a cyst from a solid lump.

Mucous cyst

A mucous cyst is a small ganglion that sits on the back of the last finger joint, between the joint crease and the nail. It almost always grows from a joint affected by osteoarthritis, usually in people over 50. It can thin the skin until it looks clear, and pressure on the nail bed can cause a vertical groove in the nail. Do not pop it with a needle at home: the cyst connects to the joint, and infection can spread into it.

Arthritis nodules

• Heberden's nodes are hard, bony swellings at the last finger joints. Bouchard's nodes form at the middle joints. Both are bone spurs from osteoarthritis. They feel rock hard, do not move, and may ache when they first form.
• Rheumatoid nodules are firm, rubbery lumps under the skin over pressure points such as the knuckles. They occur in some people with established rheumatoid arthritis.
• Gouty tophi are chalky, whitish lumps of urate crystals that build up in people with long-standing gout. They can break through the skin and leak a white, toothpaste-like material.

Giant cell tumor of the tendon sheath

This is the second most common hand lump after ganglion cysts. Despite the name, it is benign. It is a firm, rubbery, painless lump that grows slowly over months, usually on the palm side of a finger near a joint. Unlike a cyst, it does not glow under a flashlight. Surgery removes it, but it comes back in a minority of people.

Epidermoid inclusion cyst

Skin cells pushed under the surface by a small cut or puncture can form a firm, round, slow-growing lump, often on a fingertip or palm. It is common in manual workers. It is movable under the skin and may have a tiny central dimple.

Dupuytren's disease

Dupuytren's contracture begins as a firm nodule in the palm, usually below the ring or little finger. Over years, a cord can form that pulls the finger into a bent position. It is more common in men of northern European descent and in people with diabetes or who drink heavily.

Trigger finger nodule

In trigger finger a small nodule forms on the flexor tendon at the base of the finger. You may feel a tender bump in the palm that moves when the finger bends, along with catching or locking.

Other benign lumps

• Lipoma: a soft, doughy, movable fatty lump. It is uncommon in the hand but can occur in the palm. See lipoma.
• Glomus tumor: a tiny, bluish spot under the nail that causes severe, pinpoint pain, especially with cold or a light touch.
• Pyogenic granuloma: a red, raw, fast-growing lump that bleeds easily, often after a minor injury.
• Warts: rough, raised, cauliflower-like skin growths, often around the nails.
• Enchondroma: a benign cartilage growth inside a finger bone. It often shows up only when the weakened bone breaks.

Infection

An infection produces a lump that develops over hours to days and is red, warm and painful. A paronychia is a pus pocket at the nail fold. A felon is a tense, throbbing abscess in the fingertip pad. Both need prompt treatment.

Rare but serious causes

Cancers of the hand are uncommon. They include skin cancers (squamous cell carcinoma, often on sun-exposed backs of the hands, and melanoma under a nail), soft tissue sarcomas, and cancer spread from elsewhere, particularly from the lung. Warning features are rapid growth, a hard lump fixed to deeper tissue, pain at night, ulceration and a lump larger than about 5 cm.

Finger cyst vs finger nodule: how to tell them apart

People often search for this because the two can feel alike. "Cyst" means a sac containing fluid. "Nodule" is a general term for any small, solid lump.

A movable, hard finger nodule is most often a seed ganglion (which feels hard because it is tense) or a giant cell tumor. A hard nodule that does not move at all and sits right on a joint is usually a bony arthritis node. An ultrasound settles the question in most cases.

What other symptoms suggest

• Pain when gripping: seed ganglion or trigger finger.
• Numbness or tingling: a cyst or tumor pressing on a nerve, for example a volar wrist ganglion near the median nerve.
• Joint stiffness and swelling in several fingers: arthritis. See joint swelling.
• Redness, heat and throbbing: infection.
• A nail groove or nail changes: mucous cyst or a tumor under the nail.

How doctors diagnose a hand lump

Your doctor will ask how long the lump has been there, whether it changes size, whether you injured the area, and whether you have arthritis, gout or diabetes. They will feel the lump, check whether it moves, test the circulation, sensation and movement of your fingers, and may shine a light through it.

Tests depend on what they find:

• X-ray: shows bony nodes, bone spurs behind a mucous cyst, enchondroma and calcium deposits.
• Ultrasound: quickly shows whether a lump is a fluid-filled cyst or solid.
• MRI: used for solid lumps, lumps that are unclear, or before surgery.
• Biopsy: a tissue sample is taken if a solid lump is growing or looks suspicious. Lumps that could be sarcoma should be biopsied at a specialist center.
• Blood tests: uric acid for suspected gout, or inflammatory markers and rheumatoid factor for rheumatoid arthritis.

Treatment for hand and finger lumps

Watchful waiting

Painless ganglion cysts can be left alone. Many shrink or go away by themselves. Bony arthritis nodes do not need removal unless they are painful or deformed.

Non-surgical options

• Splinting for a short period can reduce pain from a ganglion that flares with activity.
• Aspiration: a doctor drains the cyst with a needle. It is quick, but the cyst comes back in about half of cases.
• Steroid injection helps trigger finger and sometimes a seed ganglion.
• Pain relief: acetaminophen (paracetamol) or ibuprofen for aching arthritis nodes. Follow the label dose. Avoid NSAIDs if you have kidney problems or a history of stomach ulcers.

Surgery

Surgical removal is offered when a lump is painful, limits function, presses on a nerve, keeps coming back or is uncertain. For a ganglion the surgeon removes the cyst and its stalk, which lowers the chance of recurrence. Mucous cyst surgery also removes the bone spur at the joint. Solid tumors are removed and sent to the lab to confirm what they are.

Treating the cause

Infections need drainage and often antibiotics. Gout is treated with urate-lowering medicine to dissolve tophi over time. Dupuytren's cords can be released with a needle, enzyme injection or surgery once they bend the finger.

Frequently asked questions

What is the difference between a finger cyst and a finger nodule?

A cyst is a sac filled with fluid, usually a ganglion or mucous cyst. It is smooth, may change size and often lets light through. A nodule is any small solid lump, such as an arthritis node, rheumatoid nodule or giant cell tumor. An ultrasound tells them apart quickly.

What is a movable hard lump on my finger?

It is most often a seed ganglion, a small, tense cyst on the tendon sheath at the base of the finger, or a giant cell tumor of the tendon sheath, a benign solid growth. Both are harmless but should be examined, and an ultrasound can confirm which it is.

Should I worry about a lump on my finger joint?

Usually not. A hard bump on the last or middle finger joint in an adult over 50 is typically an arthritis node, and a soft one near the nail is often a mucous cyst. See a doctor if it is growing fast, red and hot, very painful, or bleeding.

Can a ganglion cyst on the hand go away on its own?

Yes. Up to half of wrist and hand ganglion cysts shrink or disappear without treatment, although this can take months or years. If a cyst is painless and not affecting function, waiting is a reasonable choice.

Is a lump on the hand ever cancer?

Rarely. Most hand lumps are benign. Cancer is more likely when a lump grows quickly, is hard and fixed, is larger than about 5 cm, causes pain at night, or ulcerates. A dark, spreading streak under a nail also needs checking for melanoma.

What kind of doctor treats hand lumps?

Start with your primary care doctor, who can examine the lump and arrange an X-ray or ultrasound. You may be referred to a hand surgeon, an orthopedic or plastic surgeon who specializes in the hand, for aspiration, removal or a biopsy.