Hand tumors in children include many different types that involve bone and soft tissues. Most tumors are benign and can often be followed unless they interfere with function and require removal.
These cystic lesions arise from joints or tendon sheaths. They are most common on the dorsum of the wrist. Ganglia may cause discomfort and an annoying prominence. Review wrist radiographs to rule out ligamentous injury.
Management First confirm the diagnosis by translumination or ultrasonography. One alternative is to aspirate the cyst. This confirms the diagnosis but only temporarily resolves the symptoms, as the cyst usually recurs. If the family and child are patient, allow the cyst to resolve with time. Most cysts will resolve spontaneously. Excise persistent or symptomatic cysts. Excision, especially of the volar ganglia, may be complex and involve much deeper structures than one might expect. Recurrence is common after all methods of treatment.
Multiple osteochondromata often involve the forearm, usually at the wrist. Fingers and subungual areas may also be involved.
Clinical features Distal lesions of the ulna cause progressive shortening.
Management is controversial. Surveys of adults suggest that the deformity causes little disability and is well accepted. Others recommend early excision of the lesions and ulnar lengthening. Be aware that operative gain in motion is usually minimal, recurrence is common, and repeated procedures are often necessary.
Solitary enchondromas are common in the hand. When multiple, they may be part of the Ollier syndrome. They may be treated by curettage and grafting if symptomatic.
Dysplasia Epiphysialis Hemimelica
Dysplasia epiphysialis hemimelica is a developmental disorder causing asymmetrical epiphyseal cartilage overgrowth with accessory epiphyseal ossification. This overgrowth causes angulatory deformity, shortening, and swelling. DEH of the hand is often confused with other tumors. Manage by excising the lesions and correcting secondary deformies by osteotomies. Expect recurrence as long as the child is still growing. These lesions are not premalignant.