Skip to content

Tumors

Hand tumors: diagnosis & management of benign (ganglia, glomus) and malignant lesions (sarcomas), prioritizing functional preservation.

Overview

The management of hand and soft-tissue tumors requires a tailored approach based on histology and anatomical constraints. For benign lesions such as enchondromas, early surgical intervention in childhood may limit growth and facilitate future procedures, although longer-term follow-up is necessary to confirm the absence of recurrence or malignant transformation [2]. In cases of trigger finger caused by extraskeletal chondroma, ultrasound serves as an acceptable diagnostic modality, with surgical excision remaining the treatment of choice [22]. Similarly, high-resolution MRI and complete excision are recommended for glomus tumors to decrease recurrence rates [19].

Malignant and aggressive lesions demand rigorous oncologic principles. Wide surgical excision remains the standard of care for synovial sarcoma, with adjuvant radiation utilized for larger and deeper lesions; the role of chemotherapy remains controversial despite observed survival benefits in certain populations [7]. For soft-tissue sarcomas of the hand, long-term clinical follow-up for 10 years is advised even after adequate oncologic treatment [4]. The absence of disease on MRI should not be the sole criterion for determining the need for repeat resection in unsuspected cases [8]. Squamous cell carcinoma recurrence risk is influenced by specific tumor characteristics, whereas the excision technique itself plays a minor role in outcome [3].

Preoperative planning and multidisciplinary coordination are critical. Optimal biopsy, negative surgical margins, and the roles of adjuvant radiotherapy and chemotherapy are emphasized in managing primary malignant and metastatic tumors [10]. Biopsy must be planned as carefully as definitive surgery, and patients should be referred to a treating center prior to biopsy if the institution lacks preparedness for accurate diagnostics or definitive treatment [21]. For posterior interosseous nerve palsy due to schwannoma, preoperative MRI diagnosis and appropriate surgical approach selection are important to separate the nerve from the tumor and decrease postsurgical complications [9]. A multidisciplinary approach with detailed discussion and long-term follow-up is recommended for bony myoepithelioma to monitor for local recurrence [5]. Surgical excision remains the primary treatment for invasive skin cancer, though nonsurgical options exist for unresectable or low-grade cancers [20].

Anatomy & Pathophysiology

General Principles and Oncologic Management

Malignant tumors of the hand require a comprehensive understanding of diagnosis, staging, biopsy, resection, and amputation principles [16]. Hand surgeons must function as both oncologic and reconstructive surgeons to complete tumor resection while preserving or restoring function [76]. Surgical principles emphasize balancing the restoration of function with the maintenance of aesthetic appearance [72].

Chondrosarcoma Management: * Low-grade chondrosarcomas of the hands and feet are managed surgically with an aim to preserve function [29]. * Grade 2 and high-grade chondrosarcomas of the hands and feet require more aggressive surgical approaches [29].

Soft-Tissue Sarcomas: Limb-sparing surgery with extensive excision of sarcomas of the hand and wrist provides satisfactory oncological and functional outcomes [91]. Wide-margin operations that spare hand function are the treatment of choice for soft-tissue sarcomas of the hand [81].

Desmoid Tumors: Complete removal of desmoid tumors in the hand is very difficult due to the concentration of important structures and the invasive character of the tumor [94].

Squamous Cell Carcinoma: Evidence-based guidelines for surgical techniques and staging protocols for squamous cell carcinoma of the hand are not clearly defined, creating a dilemma where extensive excisions can be functionally debilitating [87].

Osseous Lesions and Reconstruction

Osteochondromas and Exostoses: The hand is a common location for exostoses development in patients with Multiple Hereditary Exostoses (MHE) [80]. Early surgical treatment is recommended for type A osteochondromas in pediatric digits to prevent the progression of finger deformity and improve motion [85].

Reconstruction Strategies: Three-dimensional printed, custom-made prostheses are a potential option for reconstruction after resections leaving large bone and joint defects in the hand and foot [86]. Biological reconstructions combining autologous or vascularized bone with tendon repair are preferable to prostheses for pediatric malignant tumors to ensure longevity and functional hand placement [90].

Ligamentous and Joint Pathology

Accurate diagnosis and management of hand and carpal fractures and dislocations rely on thorough physical examination and appropriate imaging to limit joint stiffness while preserving mobility and function [49]. Palmar scapholunate dislocation is a rare injury that can result in DISI malalignment and arthritis despite a normal scapholunate angle [93].

Classification

Musculoskeletal Tumor Society / American Joint Committee on Cancer: The Musculoskeletal Tumor Society staging system remains intuitive for surgeons, whereas the American Joint Committee on Cancer staging system has widespread acceptance due to its multidisciplinary nature and ability to facilitate more nuanced prediction of prognosis [47].

Benign Soft-Tissue Entities: Awareness and understanding of tumor characteristics may help physicians with diagnosis and treatment of benign hand soft tissue tumors [12]. A multidisciplinary approach can identify myopericytoma of the base of the finger as a benign entity, thereby defining the correct treatment [17]. Ancient schwannoma can be differentiated from malignant tumors using specific ultrasound and MRI findings [1]. Tumor-like conditions of the hand and upper extremity typically present as masses that can be confused with more serious conditions, requiring excisional biopsy for definitive diagnosis to guide treatment [6].

Malignant Bone and Soft-Tissue Tumors: Original classifications for entities such as benign giant-cell tumor, chondroblastoma, and chondrosarcoma are justified by follow-up reports in the third edition of "Tumors of Bone" [51]. Grade-I and II juxtacortical (parosteal) osteogenic sarcomas have a significantly better prognosis and may be amenable to en bloc resection if removed with good margins [71]. Grade-III juxtacortical (parosteal) osteogenic sarcomas have a poor prognosis despite early radical surgery and should be treated with prompt amputation and adjunctive chemotherapy [71]. Wide surgical excision is the standard of care for synovial sarcoma, with adjuvant radiation utilized for larger and deeper lesions, while the role of chemotherapy remains controversial with survival benefits observed in certain populations [7]. Management of primary malignant and metastatic tumors of the hand emphasizes optimal biopsy, negative surgical margins, and the roles of adjuvant radiotherapy and chemotherapy [10]. Specific tumor characteristics may increase the chances of recurrence in squamous cell carcinoma of the hand, while the technique of tumor excision did not have a major role in outcome [3].

Congenital and Genetic Classifications: Soft-tissue neoplasms in congenital neurofibromatosis are classified into primary neurogenic tumors and tumors of other soft-tissue structures [66]. Confirming PIK3CA mutation status allows for more accurate diagnosis and classification of isolated macrodactyly based on its molecular pathogenesis [54].

Other Considerations: Early surgical treatment of enchondromas in Ollier disease may limit lesion growth and facilitate future surgery, though long-term follow-up is needed to confirm absence of recurrence and malignant transformation [2]. Future studies are warranted to clarify whether dual-sequencing approaches can improve the identification of actionable genetic events in bone and soft-tissue sarcomas [77].

Clinical Presentation

Hand and upper extremity masses typically present as distinct lesions, though tumor-like conditions are frequently confused with more serious pathologies [6]. Diagnosis often relies on a combination of clinical examination and imaging [6]. Specific entities require high clinical suspicion to avoid misdiagnosis. Glomus tumors may be missed on magnetic resonance imaging, necessitating strong clinical awareness [15]; they should be included in the differential for neurofibromatosis patients presenting with painful hand or finger lesions [36]. Metastatic tumors are rare and often mimic acute inflammatory infections [41]. Angiomatoid fibrous histiocytoma is difficult to diagnose and prone to misdiagnosis [40]. Solitary, adult-onset, intraosseous myofibroma of the finger is uncommon and can lead to mistaken diagnosis if not recognized [35].

Malignant peripheral nerve sheath tumors (MPNST) are rare, and diagnosis is challenging due to unreliable imaging [13]. Ancient schwannoma presents with ultrasound and MRI findings that help differentiate it from malignant tumors [1]. Bizarre parosteal osteochondromatous proliferation (Nora lesion) in pediatric phalanges presents with symptoms and radiographic findings that complicate diagnosis [14]. Squamous cell carcinoma of the hand has specific characteristics that may increase recurrence chances [3]. Melanoma in the hand often presents at a later stage, posing diagnostic and management challenges with a poorer prognosis [39]. Cutaneous paraneoplastic syndrome can affect the hand in cases of underlying Waldenström macroglobulinemia [34].

Benign cartilaginous and bone tumors have specific features aiding diagnosis and known recurrence rates important for patient counseling [38]. Giant cell tumors (GCT) may present with new symptoms, particularly pain, requiring indefinite follow-up [33]. Myopericytoma of the base of the finger is a rare benign entity requiring a multidisciplinary approach for identification [17]. Digital glomus tumor recurrences can occur at specific anatomic locations; synchronous lesions may persist if not identified, necessitating careful preoperative and intraoperative examination [18]. Multiple intraneural glomus tumors on a digital nerve cause symptoms relieved by excision, but synchronous lesions may persist if not identified [37]. Malignant tumors of the hand require understanding of principles of diagnosis, staging, biopsy, resection, and amputation [16].

Investigations

Plain radiography: Plain radiography: Often identifies asymptomatic hand tumors as accidental findings, raising awareness of uncommon entities to aid differential diagnosis [70]. However, plain radiographs may fail to show peripheral ossification rims in soft-tissue giant-cell tumor recurrences [59]. In pediatric phalanges, bizarre parosteal osteochondromatous proliferation (Nora lesion) presents with challenging radiographic findings [14]. For metastatic prostate cancer to the distal phalanx, plain radiographs alone are insufficient; a high index of suspicion and thorough evaluation including biopsy are essential to avoid misdiagnosis in patients with known metastatic disease [62].

MRI: MRI: Ultrasound and MRI findings narrow the differential diagnosis for ancient schwannoma, helping differentiate it from malignant tumors [1]. Preoperative MRI diagnosis and appropriate surgical approach selection are critical in posterior interosseous nerve palsy due to schwannoma to separate the nerve from the tumor and decrease postsurgical complications [9]. High-resolution MRI is recommended for glomus tumors to ensure complete excision and decrease recurrence rates [19]. High-resolution MR imaging can indicate glomus tumor location pre-operatively, supporting the hypothesis that a new tumor developed rather than a recurrence due to incomplete excision [52]. MRI is useful in identifying and delineating osteoid osteoma lesions pre-operatively, aiding planning and precise excision [50]. In cases of chronic lymphocytic leukemia in the hand, MRI may be more useful than plain x-rays to identify bone and soft tissue extensions [48]. The absence of disease on MRI should not be the sole criterion for determining repeat resection after marginal excision of unsuspected soft tissue sarcomas of the hand [8]. Soft-tissue giant-cell tumor recurrence may be missed if MRI is not performed [59]. For undiagnosed hand tumors such as isolated peripheral T-cell lymphoma, MRI and expeditious incisional biopsy are important to avoid incorrect diagnoses and misguided treatments [63].

CT: CT: CT-scan assessment is advocated for diagnosing metastatic oesophageal carcinoma presenting in a finger and for surgical planning of wedge excision [75].

Biopsy and Pathology: Biopsy and Pathology: Diagnosis of tumor-like conditions of the hand and upper extremity often relies on clinical examination and imaging, with excisional biopsy needed for definitive diagnosis to guide treatment [6]. Diagnosis of malignant peripheral nerve sheath tumour (MPNST) is challenging due to rarity and unreliable imaging, making a high index of suspicion paramount for early diagnosis and treatment [13]. Clinical suspicion remains important in glomus tumor diagnosis, as some are not diagnosed on magnetic resonance imaging [15]. A high level of suspicion and histological study are required when there is an underlying history of malignancy [48]. A combined imaging and pathological approach is essential to identify reticular perineuriomas and avoid inappropriately aggressive therapy [67].

Other Considerations: Other Considerations: Clinical and radiographic characteristics of giant cell tumors (GCTs) of the lumbar spine are not specific [74]. Ultrasound is an acceptable imaging modality for diagnosing trigger finger caused by extraskeletal chondroma [22].

Treatment

Non-Operative

Percutaneous sclerotherapy is highlighted as a role for benign bone tumors in recent musculoskeletal tumor surgery literature [56]. For unresectable or low-grade cancers, nonsurgical options exist alongside surgical excision for invasive skin cancer of the hand [20].

Operative

Indications: Benign hand tumors located within the distal upper limb have a clear indication for surgery according to patient-rated outcome measures [61]. Early surgical treatment of enchondromas in Ollier disease may limit lesion growth and facilitate future surgery, though longer-term follow-up is needed to confirm the absence of recurrence and malignant transformation [2]. In the setting of nonmetastatic angiosarcoma in the upper extremity, amputation is the treatment of choice, although the tumor uniformly has a poor survival rate [44].

Surgical Approach / Technique: Wide surgical excision is the standard of care for definitive treatment of synovial sarcoma, with adjuvant radiation utilized for larger and deeper lesions [7]. Surgical management with curettage is the standard of care for symptomatic enchondroma of the hand, with most patients returning to full function after surgery [55]. Complete surgical excision is uniformly curative for leiomyoma of the hand, as this tumor has never been reported to metastasize [46]. Osteochondrolipoma of the hand usually does not recur after complete excision, with a prognosis similar to that of benign lipoma [11]. Surgical management of low-grade chondrosarcoma of the hands and feet should aim to preserve function, while grade 2 and high-grade tumors require more aggressive approaches [29]. Preoperative diagnosis by MRI and selection of the appropriate surgical approach are important for separating the nerve from the tumor and decreasing the risk of postsurgical complications in posterior interosseous nerve palsy due to schwannoma [9]. Multidisciplinary management combining neoadjuvant modern targeted oral chemotherapy with staged conservative surgical resection led to successful tumor eradication and near full hand function at 2-year follow-up for infantile fibrosarcoma of the hand [64].

Adjuncts: The role of chemotherapy in synovial sarcoma remains controversial, with survival benefits observed in certain populations [7]. The effectiveness of chemotherapy regimens for sarcoma correlates with the extent of tumor necrosis [43].

Other Considerations: Ancient schwannoma can be differentiated from malignant tumors using a combination of ultrasound and MRI findings [1]. Specific tumor characteristics may increase the chances of recurrence in squamous cell carcinoma of the hand, while the technique of tumor excision did not have a major role in outcome [3]. Long-term clinical follow-up (10 years) is advised for soft-tissue sarcoma of the hand even with adequate oncologic treatment [4]. A multi-disciplinary approach with detailed discussion and long-term follow-up is recommended for bony myoepithelioma to monitor for local recurrence [5]. The absence of disease on MRI should not be used as the sole criterion for determining whether a repeat resection should be performed after marginal excision of unsuspected soft tissue sarcomas of the hand [8]. Survival after limb-preserving surgery for soft-tissue sarcoma in the hand is similar to survival after more radical surgical approaches [53]. Optimal biopsy, negative surgical margins, and the roles of adjuvant radiotherapy and chemotherapy are emphasized in the management of primary malignant and metastatic tumors of the hand [10]. Surgical resection is the main treatment for intraperitoneal extraosseous osteosarcoma, but the prognosis is poor [45]. Biopsy should be planned as carefully as definitive surgery, and patients should be referred to a treating center prior to biopsy if the institution is not prepared to perform accurate diagnostic studies or proceed with definitive treatment [21].

Complications

Oncologic Recurrence and Malignant Transformation: Differentiation from malignant tumors is critical, particularly for ancient schwannoma [1]. Early surgical treatment of enchondromas in Ollier disease requires longer-term follow-up to confirm the absence of recurrence and malignant transformation [2]. Multi-disciplinary approaches with long-term follow-up are recommended for bony myoepithelioma [5] and intraosseous myoepithelioma [23] to monitor the possibility of local recurrence. Differentiation from chondrosarcoma is important due to the benign clinical course of chondromyxoid fibroma of bone [30]. Recurrence of chondrosarcoma of the extraskeletal soft tissues has been reported as early as two months and as late as fifteen years after the primary operation [31]; all patients with this condition should be carefully followed due to the variable timing of recurrence [31]. A secondary malignant tumor can develop as long as twenty-five years after the initial presentation of a benign giant-cell tumor [28], and the development of nodules of recurrent tumor within a surgical scar may occur long after excision of the primary bone lesion in giant-cell tumor of bone [60]. Malignant transformation of an aneurysmal bone cyst into a malignant fibrous histiocytoma is possible [78].

Long-Term Surveillance Requirements: Long-term clinical follow-up (10 years) is advised for soft-tissue sarcoma of the hand despite adequate oncologic treatment [4]. Vigilant and appropriate follow-up is necessary to detect metastases early in primary paraganglioma of the distal thumb [65]. The natural history of angioblastic tumors of bone and skin remains unclear despite adequate local excision being appropriate therapy [73]. More cases are needed to determine the natural history and optimal management options for extra-axial chordoma of the hand [79]. The rare nature of malignant glomus tumors mandates case presentation and longitudinal analysis to help guide surgical management and optimize outcomes [32].

Specific Tumor Recurrence Risks: Tumors usually do not recur after complete excision of osteochondrolipoma [11]. Patients with digital glomus tumor should be informed of the risk of recurrent symptoms [18], and a careful preoperative and intraoperative examination for synchronous lesions should be made in digital glomus tumor [18]. With 5-year follow-up, recurrence is unlikely in Merkel cell tumor of the hand [25]. After 2 years of follow-up, there is no evidence of local recurrence or metastatic dissemination in epithelioid sarcoma in the median nerve of the hand [24]. After aggressive surgical management with negative margins, 71% of patients with epithelioid sarcoma of the hand were alive without evidence of disease at last followup [26], and the 5- and 10-year survivorship for epithelioid sarcoma of the hand is 85% [26]. A history of extensive recurrent disease well removed from the primary tumor is associated with a poor prognosis in extensive cutaneous metastatic breast carcinoma of the hand and upper extremity [27].

Other Considerations:

Recovery

Light activity (weeks): Specific timelines for light activity are not defined in the current evidence base.

Full activity (months): Specific timelines for full activity are not defined in the current evidence base.

Complete recovery / outcome plateau (months): Specific timelines for complete recovery are not defined in the current evidence base.

Rehabilitation protocol: Specific rehabilitation protocols are not defined in the current evidence base.

Functional milestones: Ray amputation with tumor-free excision margins yields satisfactory long-term functional results for sarcoma of the hand [58]. Despite residual high-grade sarcoma at the surgical site, a patient with extraskeletal osteosarcoma of the hand achieved negative margins and maintained good functional outcomes at 7-month follow-up [69].

Other Considerations: Early surgical treatment of enchondromas in childhood may limit the growth of large lesions and facilitate future surgery, though longer-term follow-up is needed to confirm the absence of recurrence and malignant transformation [2]. Long-term clinical follow-up for 10 years is advised for soft-tissue sarcoma of the hand, even with adequate oncologic treatment [4]. A multi-disciplinary approach with detailed discussion and long-term follow-up is recommended for bony myoepithelioma to monitor the possibility of local recurrence [5]. Chondromyxoid fibroma has a benign clinical course, making differentiation from chondrosarcoma important [30]. The prognosis for osteochondrolipoma of the hand is the same as with benign lipoma, and tumors usually do not recur after complete excision [11]. A multi-disciplinary approach with long-term follow-up is recommended for intraosseous myoepithelioma to monitor for local recurrence [23]. After 2 years of follow-up, there was no evidence of local recurrence or metastatic dissemination in a case of epithelioid sarcoma in the median nerve of the hand [24]. With 5-year follow-up, recurrence is unlikely for Merkel cell tumor of the hand [25]. After aggressive surgical management with negative margins, 71% of patients with epithelioid sarcoma of the hand were alive without evidence of disease at last follow-up, with a 5- and 10-year survivorship of 85% [26]. A history of extensive recurrent disease well removed from the primary tumor is associated with a poor prognosis in cases of extensive cutaneous metastatic breast carcinoma of the hand and upper extremity [27]. A secondary malignant tumor can develop as long as 25 years after the initial presentation of a benign giant-cell tumor [28]. Recurrence of chondrosarcoma of the extraskeletal soft tissues has been reported as early as two months and as late as 15 years after the primary operation, requiring careful follow-up for all patients [31]. The rare nature of malignant glomus tumors mandates case presentation and longitudinal analysis to help guide surgical management and optimize outcomes [32]. Ray amputation with tumor-free excision margins allows for early return to daily activities, yields satisfactory long-term functional results, has a low risk of lower local recurrences, and provides good survival rates for sarcoma of the hand [58]. Despite residual high-grade sarcoma at the surgical site, a patient with extraskeletal osteosarcoma of the hand achieved negative margins and maintained good functional outcomes at 7-month follow-up [69]. The presence of a metastatic lesion in the hand or skin carries an ominous prognosis, with a median survival of a few months [88]. In cases of Ewing’s sarcoma of the hand, there were no local recurrences, but two patients developed metastases and died, while three were alive and free of disease at last follow-up [92].

Key Evidence

  • [L4] The combination of ultrasound and MRI findings provides features that narrow the differential diagnosis for ancient schwannoma, helping to differentiate it from malignant tumors. (10.1016/j.jhsa.2011.08.009)
  • [L4] Early surgical treatment may limit the growth of large lesions and facilitate future surgery, though longer-term follow-up is needed to confirm the absence of recurrence and malignant transformation. (10.1016/j.jhsa.2018.02.010)
  • [L4] Specific characteristics of the tumor may increase chances of recurrence, while the technique of tumor excision did not have a major role in outcome. (10.1016/j.jhsa.2013.08.090)
  • [L4] Even with adequate oncologic treatment, long-term clinical follow-up (10 years) is advised as they should not be deceived by their smaller size. (10.5435/jaaos-d-20-00434)
  • [L4] We recommend a multi-disciplinary approach to such tumours with detailed discussion and long-term follow-up to monitor the possibility of local recurrence. (10.1177/1753193415601553)
  • [L5] Tumor-like conditions of the hand and upper extremity typically present as masses and can be confused with more serious conditions; diagnosis often relies on clinical examination and imaging, with excisional biopsy needed for definitive diagnosis to guide treatment. (10.1016/j.jhsa.2017.09.012)
  • [L4] Wide surgical excision remains the standard of care for definitive treatment with adjuvant radiation utilized for larger and deeper lesions, while the role of chemotherapy remains controversial with survival benefits observed in certain populations. (10.3390/curroncol28030177)
  • [L3] The absence of disease on MRI should not be used as the sole criterion in determining whether a repeat resection should be performed. (10.1016/j.jhsa.2010.05.009)
  • [Case_report] Preoperative diagnosis by MRI and selection of the appropriate surgical approach are important in these cases because they give clinicians the best chance to separate the nerve from the tumor and decrease the risk of postsurgical complications. (10.1016/j.jhsa.2008.05.033)
  • [L5] The article provides an update on current management of primary malignant and metastatic tumors of the hand, emphasizing the importance of optimal biopsy, negative surgical margins, and the roles of adjuvant radiotherapy and chemotherapy. (10.1016/j.jhsa.2010.08.014)
  • [L4] The prognosis is the same as with benign lipoma, and the tumors usually do not recur after complete excision. (10.1016/j.jhsa.2021.05.024)
  • [L4] Awareness and understanding of tumor characteristics may help physicians with diagnosis and treatment. (10.1177/1558944720928499)
  • [L4] Diagnosis of MPNST can be challenging due to the rarity of these tumours and unreliable imaging, making a high index of suspicion paramount for early diagnosis and treatment. (10.1177/1753193408092039)
  • [L4] The diagnosis in pediatric cases can be challenging due to presenting symptoms and radiographic findings. (10.1016/j.jhsa.2020.05.002)
  • [L4] These findings highlight the continued importance of clinical suspicion in glomus tumor diagnosis. (10.1016/j.jhsa.2014.12.002)
  • [L5] It is imperative to understand the principles of diagnosis, staging, biopsy, resection, and amputation before treating malignant tumors of the hand. (10.5435/jaaos-d-20-00333)
  • [L4] A multidisciplinary approach can identify this lesion as being benign and thus define the correct treatment. (10.1016/j.jhsa.2018.03.015)
  • [L4] A careful preoperative and intraoperative examination for synchronous lesions should be made, and patients should be informed of the risk of recurrent symptoms. (10.1016/j.jhsa.2010.02.019)
  • [Case_report] They recommend using high-resolution MRI and ensuring complete excision to decrease recurrence rates. (10.1111/sae.12041)
  • [L5] Surgical excision remains the primary treatment for invasive tumors, though nonsurgical options exist for unresectable or low-grade cancers. (10.5435/jaaos-d-14-00040)
  • [L4] The authors suggest that the biopsy should be planned as carefully as definitive surgery and that patients should be referred to a treating center prior to biopsy if the institution is not prepared to perform accurate diagnostic studies or proceed with definitive treatment. (10.2106/00004623-198264080-00002)
  • [L4] Ultrasound is an acceptable imaging modality for diagnosis, and surgical excision is the treatment of choice. (10.1016/j.jhsa.2016.10.003)
  • [L4] A multi-disciplinary approach with long-term follow-up is recommended to monitor for local recurrence. (10.1177/1753193416676229)
  • [Case_report] After 2 years of follow-up, there is no evidence of local recurrence or metastatic dissemination. (10.1177/15589447211030689)
  • [L4] With both patients at 5-year follow-up, recurrence is unlikely. (10.1016/j.jhsa.2007.12.003)
  • [L4] After aggressive surgical management with negative margins, 71% of the patients were alive without evidence of disease at the last followup, with a 5- and 10-year survivorship of 85%. (10.1097/01.blo.0000150317.50594.96)
  • [Case_report] A history of extensive recurrent disease well removed from the primary tumor is associated with a poor prognosis. (10.1016/j.jhsa.2006.10.022)
  • [Case_report] This case demonstrates that a secondary malignant tumor can develop as long as twenty-five years after the initial presentation of a benign giant-cell tumor, a latency period longer than previously recorded. (10.2106/00004623-198971050-00019)
  • [L3] For low-grade CSs of the hands and feet, surgical management should aim to preserve function, while grade 2 and high-grade tumours require more aggressive approaches. (10.1302/0301-620x.103b3.bjj-2020-1337.r1)
  • [L4] The rare nature of malignant glomus tumors mandates case presentation and longitudinal analysis to help guide surgical management and optimize outcomes. (10.1177/1558944715614874)
  • [L4] Patients with GCT should be followed indefinitely, and referred promptly if new symptoms, particularly pain, emerge. (10.1302/0301-620x.104b12.bjj-2022-0401.r1)
  • [Case_report] It shows that a lower threshold for further workup in patients with atypical signs and symptoms allows for the potential to identify potential malignancy earlier. (10.1177/15589447231151260)
  • [L5] Awareness of this uncommon tumor in adult patients is essential to prevent mistaken diagnosis and subsequent extensive workup. (10.1007/s11552-014-9729-4)
  • [L3] Glomus tumor should be included in the differential diagnosis in neurofibromatosis patients who present with a painful lesion of the hand or finger. (10.1016/j.jhsa.2013.05.025)
  • [Case_report] Excision of the tumor relieves symptoms in most patients, but clinicians should search for synchronous glomus tumors during excision to avoid recurrence or persistence of symptoms due to undiscovered multiple lesions. (10.1016/j.jhsa.2013.07.024)
  • [L4] Awareness of tumor features may help physicians with diagnosis, and awareness of recurrence rates is important when counseling patients. (10.1177/1558944720922921)
  • [L5] Melanoma in the hand poses additional diagnostic and management challenges, often presenting at a later stage with a poorer prognosis. (10.1177/17531934241245028)
  • [L4] AFH is a rare tumor that is difficult to diagnose, often leading to misdiagnosis and inadequate treatment by referring physicians. (10.1186/s12891-017-1390-y)
  • [L4] Metastatic tumors to the hand are rare and often present as acute inflammatory lesions mimicking infection; histological examination is the most desirable criterion for diagnosis, and amputation is frequently the best treatment method. (10.2106/00004623-195840020-00003)
  • [L5] The effectiveness of the chemotherapy regimen correlates with the extent of tumor necrosis. (10.5435/jaaos-21-08-480)
  • [Case_report] In the setting of nonmetastatic disease, amputation is the treatment of choice; however, this aggressive tumor uniformly has a poor survival rate. (10.1177/1558944717702466)
  • [Case_report] Surgical resection is the main treatment and the prognosis is poor. (10.1186/s12891-020-03429-5)
  • [L5] Treatment is complete surgical excision, which is uniformly curative, as this tumor has never been reported to metastasize. (10.1007/s11552-008-9143-x)
  • [L5] While the Musculoskeletal Tumor Society system remains intuitive for surgeons, the American Joint Committee on Cancer staging system has widespread acceptance due to its multidisciplinary nature and ability to facilitate more nuanced prediction of prognosis. (10.5435/jaaos-d-17-00055)
  • [L4] A high level of suspicion and histological study are required when there is an underlying history of malignancy, and MRI may be more useful than plain x-rays to identify bone and soft tissue extensions. (10.1016/j.jhsa.2020.03.014)
  • [L4] MRI is useful in identifying and delineating such lesions pre-operatively and aids pre-operative planning and precise surgical excision of the tumour. (10.1177/1753193408089575)
  • [L5] This third edition presents an even more complete review of all available material on tumors of bone, with follow-up reports justifying original classifications for entities such as benign giant-cell tumor, chondroblastoma, and chondrosarcoma. (10.2106/00004623-195032010-00029)
  • [L4] High resolution MR imaging indicated a new (palmar) location of the tumour before the last operation, supporting the hypothesis that a new tumour had developed rather than a recurrence due to incomplete excision. (10.1054/jhsb.1998.0047)
  • [L4] Survival was similar to the survival after a more radical surgical approach reported in the literature. (10.1177/1753193419899037)
  • [L4] Confirming PIK3CA mutation status allows for more accurate diagnosis and classification of the disease based on its molecular pathogenesis. (10.1177/1753193418770366)
  • [L4] Surgical management with curettage is the standard of care for symptomatic lesions, with most patients returning to full function after surgery. (10.5435/jaaos-d-15-00452)
  • [L5] The field of musculoskeletal tumor surgery continues to advance through multidisciplinary collaboration, with recent literature highlighting the importance of aggressive surgical resection for non-sacral pelvic Ewing sarcoma, the prognostic value of preoperative imaging in osteosarcoma and chondrosarcoma, and the role of percutaneous sclerotherapy for benign bone tumors. (10.2106/jbjs.20.01510)
  • [L3] Ray amputation with tumour-free excision margins allows for early return to daily activities and yields satisfactory long-term functional results, low risk of lower local recurrences and good survival rates. (10.1177/1753193419885039)
  • [L4] A soft-tissue recurrence of giant-cell tumor may not be recognized if a thorough physical examination is not performed and magnetic resonance imaging studies are not carried out, as plain radiographs may not show a peripheral rim of ossification. (10.2106/00004623-199905000-00012)
  • [L4] The development of nodules of recurrent tumor within a surgical scar may occur long after excision of the primary bone lesion. (10.2106/00004623-196749020-00016)
  • [L4] According to the results of PROM, benign hand tumors located within the distal upper limb have a clear indication for surgery. (10.1016/j.jhsa.2015.06.078)
  • [Case_report] A high index of suspicion and thorough evaluation including radiographs and biopsy are essential to avoid misdiagnosis in patients with known metastatic disease. (10.1177/15589447211028922)
  • [Case_report] This case illustrates the importance of MRI and expeditious incisional biopsy in the setting of an undiagnosed hand tumor, as initial incorrect diagnoses led to misguided treatments. (10.1016/j.jhsa.2014.01.033)
  • [L4] Multidisciplinary management combining neoadjuvant modern targeted oral chemotherapy with staged conservative surgical resection led to successful tumor eradication and near full hand function at 2-year follow-up. (10.1016/j.jhsg.2025.100887)
  • [L4] Vigilant and appropriate follow-up is necessary to detect metastases early. (10.1016/j.jhsa.2016.02.002)
  • [L4] Soft-tissue neoplasms in congenital neurofibromatosis are classified into primary neurogenic tumors and tumors of other soft-tissue structures. (10.2106/00004623-195638040-00001)
  • [L4] A combined imaging and pathological approach is essential to identify perineuriomas and thereby avoid inappropriately aggressive therapy. (10.1016/j.jhsa.2016.11.009)
  • [L4] This case highlights a unique telangiectatic histologic subtype and demonstrates that despite residual high-grade sarcoma at the surgical site, the patient achieved negative margins and maintained good functional outcomes at 7-month follow-up. (10.1016/j.jhsa.2017.09.007)
  • [L4] This study furthermore raises awareness about uncommon or rare tumours and helps clinicians to establish proper differential diagnosis, as the majority of detected tumours of the hand are asymptomatic and accidental findings on radiographs. (10.1186/1471-2474-15-182)
  • [L5] GCTs of the lumbar spine are rare and their clinical and radiographic characteristics are not specific. (10.1016/j.otsr.2010.05.009)
  • [L4] CT-scan assessment is advocated for diagnosis of this condition and for surgical planning of the wedge excision. (10.1177/1753193408089528)
  • [L5] Hand surgeons must act as both oncologic and reconstructive surgeons to complete tumor resection while preserving or restoring function. (10.1016/j.jhsa.2011.11.019)
  • [L4] Future studies evaluating different test types on the same tumor specimens are warranted to clarify whether the dual-sequencing approaches can improve the identification of actionable genetic events. (10.2106/jbjs.25.01105)
  • [L4] This case suggests the possibility of malignant transformation of an aneurysmal bone cyst into a malignant fibrous histiocytoma, as the long disease-free period and histological review make a missed malignant focus unlikely. (10.2106/00004623-200201000-00016)
  • [L4] More cases are needed to determine the natural history and optimal management options. (10.1016/j.jhsa.2017.05.033)
  • [L4] The hand is a common location of exostoses development for MHE patients. (10.1016/j.jhsa.2020.12.011)
  • [L4] An operation with wide margins that spares the function of the hand is the treatment of choice for patients who have a soft-tissue sarcoma of the hand. (10.2106/00004623-199504000-00009)
  • [L4] Endoscopic carpal tunnel release is a useful and safe alternative when performed by a surgeon familiar with hand anatomy and trained in endoscopic techniques, though it is more complex than standard open procedures. (10.1007/s001670050097)
  • [L4] For type A osteochondromas, early surgical treatment is recommended to prevent the progress of finger deformity and to improve motion. (10.1016/j.jhsa.2010.11.038)
  • [L4] These preliminary findings suggest that 3D implants may be an option for reconstruction after resections that leave large bone and joint defects in the hand and foot. (10.1097/corr.0000000000002730)
  • [L5] Evidence-based guidelines for surgical techniques and staging protocols for squamous cell carcinoma of the hand have not been clearly defined, creating a dilemma where extensive excisions can be functionally debilitating. (10.1016/j.jhsa.2011.03.018)
  • [Case_report] The presence of a metastatic lesion in the hand or skin carries an ominous prognosis, with a median survival of a few months. (10.1016/j.jhsa.2007.01.001)
  • [L4] Biological reconstructions combining autologous or vascularized bone with tendon repair are preferable to prostheses for pediatric malignant tumors to ensure longevity and functional hand placement. (10.1530/eor-2025-0149)
  • [Paper] Limb-sparing surgery with extensive excision of sarcomas of the hand and wrist seems to provide satisfactory oncological and functional outcomes. (10.1016/j.otsr.2016.01.026)
  • [L4] There were no local recurrences, but two patients developed metastases and died, while the other three were alive and free of disease at last follow-up. (10.1177/1753193408094922)
  • [L4] Palmar scapholunate dislocation is a rare injury that can result in DISI malalignment and arthritis despite a normal scapholunate angle, as demonstrated in this case with an 8-year follow-up. (10.1177/1753193409360738)
  • [L4] Complete removal of desmoid tumours in the hand is very difficult due to the concentration of important structures and the invasive character of the tumour. (10.1054/jhsb.1999.0241)

See Also

References

[1] Ancient Schwannoma of the Hand. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.08.009

[2] Surgical Treatment of Enchondromas of the Hand During Childhood in Ollier Disease. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.02.010

[3] Squamous Cell Carcinoma of the Hand: A 20-Year Review. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.090

[4] Soft-tissue Sarcoma of the Hand: Patient Characteristics, Treatment, and Oncologic Outcomes. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-00434

[5] Bony myoepithelioma: a rare condition presenting in the hand. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415601553

[6] Tumor-Like Conditions of the Hand and Upper Extremity. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.09.012

[7] Synovial Sarcoma: A Clinical Review. Current Oncology. 2021. DOI: 10.3390/curroncol28030177

[8] Predictive Value of Magnetic Resonance Imaging in Determining Presence of Residual Disease After Marginal Excision of Unsuspected Soft Tissue Sarcomas of the Hand. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.05.009

[9] Posterior Interosseous Nerve Palsy Due to Schwannoma: Case Report. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.05.033

[10] Malignant and Metastatic Tumors of the Hand. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.08.014

[11] Osteochondrolipoma of the Hand. The Journal of Hand Surgery. 2022. DOI: 10.1016/j.jhsa.2021.05.024

[12] Benign Hand Tumors (Part II): Soft Tissue Tumors. HAND. 2020. DOI: 10.1177/1558944720928499

[13] Re: Malignant peripheral nerve sheath tumour of the hand: challenges in diagnosis and management of a child. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408092039

[14] Bizarre Parosteal Osteochondromatous Proliferation (Nora Lesion) in Pediatric Phalanges. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.05.002

[15] Characteristics of Glomus Tumors in the Hand Not Diagnosed on Magnetic Resonance Imaging. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.12.002

[16] Malignant Tumors of the Hand. Journal of the American Academy of Orthopaedic Surgeons. 2020. DOI: 10.5435/jaaos-d-20-00333

[17] Myopericytoma of the Base of the Finger: Radiological and Pathological Description of a Rare Benign Entity. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.03.015

[18] The Anatomic Location of Digital Glomus Tumor Recurrences. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.02.019

[19] A Glomus Tumour of the Elbow: A Case Report and Review of the Literature. Shoulder & Elbow. 2014. DOI: 10.1111/sae.12041

[20] Skin Cancer of the Hand. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-14-00040

[21] The hazards of biopsy in patients with malignant primary bone and soft-tissue tumors.. The Journal of Bone & Joint Surgery. 1982. DOI: 10.2106/00004623-198264080-00002

[22] Trigger Finger Caused by Extraskeletal Chondroma. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2016.10.003

[23] Intraosseous myoepithelioma: a rare tumour in the hand. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193416676229

[24] Epithelioid Sarcoma in the Median Nerve of the Hand: A Case Report. HAND. 2021. DOI: 10.1177/15589447211030689

[25] Merkel Cell Tumor of the Hand: Report of Two Cases. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.12.003

[26] Epithelioid Sarcoma of the Hand. Clinical Orthopaedics & Related Research. 2005. DOI: 10.1097/01.blo.0000150317.50594.96

[27] Extensive Cutaneous Metastatic Breast Carcinoma of the Hand and Upper Extremity: A Case Report. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2006.10.022

[28] Recurrence of a giant-cell tumor with malignant transformation to a fibrosarcoma twenty-five years after primary treatment. A case report.. The Journal of Bone & Joint Surgery. 1989. DOI: 10.2106/00004623-198971050-00019

[29] Chondrosarcoma of the hands and feet. The Bone & Joint Journal. 2021. DOI: 10.1302/0301-620x.103b3.bjj-2020-1337.r1

[30] CHONDROMYXOID FIBROMA OF BONE: Report of Two Cases.. The Journal of Bone and Joint Surgery. American Volume. 1953.

[31] Chondrosarcoma of the Extraskeletal Soft Tissues: A REPORT OF SEVEN CASES AND REVIEW OF THE LITERATURE.. The Journal of Bone and Joint Surgery. American Volume. 1967.

[32] Malignant Glomus Tumors of the Hand. HAND. 2016. DOI: 10.1177/1558944715614874

[33] A systematic review of multicentric giant cell tumour with the presentation of three cases at long-term follow-up. The Bone & Joint Journal. 2022. DOI: 10.1302/0301-620x.104b12.bjj-2022-0401.r1

[34] Cutaneous Paraneoplastic Syndrome Affecting the Hand in a Case of Underlying Waldenström Macroglobulinemia. HAND. 2023. DOI: 10.1177/15589447231151260

[35] Solitary, Adult-Onset, Intraosseous Myofibroma of the Finger: Report of a Case and Review of Literature. HAND. 2014. DOI: 10.1007/s11552-014-9729-4

[36] The Association Between Glomus Tumors and Neurofibromatosis. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.05.025

[37] Multiple Intraneural Glomus Tumors on a Digital Nerve: Case Report. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.07.024

[38] Benign Hand Tumors (Part I): Cartilaginous and Bone Tumors. HAND. 2020. DOI: 10.1177/1558944720922921

[39] Malignant melanoma in the hand: current evidence and recommendations. Journal of Hand Surgery (European Volume). 2024. DOI: 10.1177/17531934241245028

[40] Angiomatoid fibrous histiocytoma: a series of seven cases including genetically confirmed aggressive cases and a literature review. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1390-y

[41] Metastatic Tumors of the Hand. The Journal of Bone & Joint Surgery. 1958. DOI: 10.2106/00004623-195840020-00003

[43] Sarcoma Chemotherapy. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/jaaos-21-08-480

[44] Case Report: Angiosarcoma in the Upper Extremity Related to a Nonfunctioning Arteriovenous Fistula. HAND. 2017. DOI: 10.1177/1558944717702466

[45] Intraperitoneal extraosseous osteosarcoma: a case report and literatures review. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03429-5

[46] Leiomyoma of the Hand. HAND. 2008. DOI: 10.1007/s11552-008-9143-x

[47] Staging of Bone and Soft-tissue Sarcomas. Journal of the American Academy of Orthopaedic Surgeons. 2018. DOI: 10.5435/jaaos-d-17-00055

[48] Unusual Manifestation of Chronic Lymphocytic Leukemia in the Hand. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.03.014

[49] Chapter 29 Hand/Carpal Fractures and Dislocations. 2021.

[50] Re: An unusual presentation of osteoid osteoma inside a metacarpal boss. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408089575

[51] Tumors of Bone. Ed. 3. Charles F. Geschickter, M.D., and Murray M. Copeland, M.D. Philadelphia, J. B. Lippincott Company, 1949. $17.50. The Journal of Bone & Joint Surgery. 1950. DOI: 10.2106/00004623-195032010-00029

[52] A Glomus Tumour with Four Recurrences. Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1998.0047

[53] Limb preserving surgery for soft-tissue sarcoma in the hand: a retrospective study of 51 cases. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193419899037

[54] An investigation of PIK3CA mutations in isolated macrodactyly. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418770366

[55] Enchondroma of the Hand: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-15-00452

[56] What’s New in Musculoskeletal Tumor Surgery. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.20.01510

[58] Extended ray resection for sarcoma of the hand: long-term survival and functional results. Journal of Hand Surgery (European Volume). 2019. DOI: 10.1177/1753193419885039

[59] Recurrent Giant-Cell Tumor Presenting as a Soft-Tissue Mass. A Report of Four Cases. The Journal of Bone & Joint Surgery*. 1999. DOI: 10.2106/00004623-199905000-00012

[60] Soft-Tissue Recurrence of Giant-Cell Tumor of Bone after Irridiation and Excision. The Journal of Bone & Joint Surgery. 1967. DOI: 10.2106/00004623-196749020-00016

[61] Benign Hand Tumors Have a Clear Indication for Surgery According to the Patient-rated Outcome Measures. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.06.078

[62] A Case of Metastatic Prostate Cancer to the Distal Phalanx. HAND. 2021. DOI: 10.1177/15589447211028922

[63] Atypical Presentation of Isolated Peripheral T-Cell Lymphoma in the Hand: Case Report. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.01.033

[64] Infantile Fibrosarcoma of the Hand: Limb-Sparing Treatment With Modern Targeted Oral Chemotherapy and Conservative Surgical Resection. Journal of Hand Surgery Global Online. 2026. DOI: 10.1016/j.jhsg.2025.100887

[65] A Peculiar Primary Paraganglioma of the Distal Thumb. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2016.02.002

[66] Soft-Tissue Neoplasms Associated with Congenital Neurofibromatosis. The Journal of Bone & Joint Surgery. 1956. DOI: 10.2106/00004623-195638040-00001

[67] Reticular Perineurioma of the Hand: Diagnosis and Treatment of a Rare Case of Hand Mass. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2016.11.009

[69] Extraskeletal Osteosarcoma of the Hand. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.09.007

[70] Incidence, histopathologic analysis and distribution of tumours of the hand. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-182

[71] Juxtacortical (parosteal) osteogenic sarcoma: histological grading and prognosis.. The Journal of Bone and Joint Surgery. American Volume. 1977.

[72] 9. Hand Surgery. 2013.

[73] Angioblastic Tumors of Bone and Skin: REPORT OF A CASE.. The Journal of Bone and Joint Surgery. American Volume. 1963.

[74] Giant cells tumor recurrence at the third lumbar vertebra. Orthopaedics & Traumatology: Surgery & Research. 2010. DOI: 10.1016/j.otsr.2010.05.009

[75] Re: Metastatic oesophageal carcinoma presenting in a finger. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408089528

[76] Cutaneous Malignancies of the Upper Extremity. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.11.019

[77] Differences Among Genomic Profiling Tests for Bone and Soft-Tissue Sarcomas in a Universal Health Insurance System. Journal of Bone and Joint Surgery. 2026. DOI: 10.2106/jbjs.25.01105

[78] Malignant Fibrous Histiocytoma at the Site of a Previously Treated Aneurysmal Bone Cyst. The Journal of Bone and Joint Surgery-American Volume. 2002. DOI: 10.2106/00004623-200201000-00016

[79] Extra-Axial Chordoma of the Hand. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.05.033

[80] Natural History and Characteristics of Hand Exostoses in Multiple Hereditary Exostoses. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.12.011

[81] Treatment of soft-tissue sarcomas of the hand.. The Journal of Bone & Joint Surgery. 1995. DOI: 10.2106/00004623-199504000-00009

[84] Difficulties and early results of the endoscopic carpal tunnel release using the modified Chow technique. Knee Surgery, Sports Traumatology, Arthroscopy. 1998. DOI: 10.1007/s001670050097

[85] Surgical Treatment for Osteochondromas in Pediatric Digits. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.11.038

[86] What Are the MSTS Scores and Complications Associated With the Use of Three-dimensional Printed, Custom-made Prostheses in Patients Who Had Resection of Tumors of the Hand and Foot?. Clinical Orthopaedics & Related Research. 2023. DOI: 10.1097/corr.0000000000002730

[87] Squamous Cell Carcinoma of the Hand. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.03.018

[88] A Rare Metastasis in the Hand: A Case of Cutaneous Metastasis of Choriocarcinoma to the Small Finger. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.01.001

[90] The most common bone tumors of the upper extremity in childhood and adolescence and their treatment: a review of the current literature. EFORT Open Reviews. 2026. DOI: 10.1530/eor-2025-0149

[91] Extensive limb-sparing surgery with reconstruction for sarcoma of the hand and wrist. Orthopaedics & Traumatology: Surgery & Research. 2016. DOI: 10.1016/j.otsr.2016.01.026

[92] Ewing’s Sarcoma of the Hand. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408094922

[93] An unusual case of multiple hand enchondromas. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193409360738

[94] Desmoid Tumours of the Hand. Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1999.0241

Creative Commons BY-NC 4.0

CC Creative Commons licence
BY Attribution — you must credit the source
NC NonCommercial — not for commercial use

Attribution-NonCommercial 4.0 International

Creative Commons Corporation ("Creative Commons") is not a law firm and does not provide legal services or legal advice. Distribution of Creative Commons public licenses does not create a lawyer-client or other relationship. Creative Commons makes its licenses and related information available on an "as-is" basis. Creative Commons gives no warranties regarding its licenses, any material licensed under their terms and conditions, or any related information. Creative Commons disclaims all liability for damages resulting from their use to the fullest extent possible.

Using Creative Commons Public Licenses

Creative Commons public licenses provide a standard set of terms and conditions that creators and other rights holders may use to share original works of authorship and other material subject to copyright and certain other rights specified in the public license below. The following considerations are for informational purposes only, are not exhaustive, and do not form part of our licenses.

Considerations for licensors: Our public licenses are intended for use by those authorized to give the public permission to use material in ways otherwise restricted by copyright and certain other rights. Our licenses are irrevocable. Licensors should read and understand the terms and conditions of the license they choose before applying it. Licensors should also secure all rights necessary before applying our licenses so that the public can reuse the material as expected. Licensors should clearly mark any material not subject to the license. This includes other CC- licensed material, or material used under an exception or limitation to copyright. More considerations for licensors: wiki.creativecommons.org/Considerations_for_licensors

Considerations for the public: By using one of our public licenses, a licensor grants the public permission to use the licensed material under specified terms and conditions. If the licensor's permission is not necessary for any reason--for example, because of any applicable exception or limitation to copyright--then that use is not regulated by the license. Our licenses grant only permissions under copyright and certain other rights that a licensor has authority to grant. Use of the licensed material may still be restricted for other reasons, including because others have copyright or other rights in the material. A licensor may make special requests, such as asking that all changes be marked or described. Although not required by our licenses, you are encouraged to respect those requests where reasonable. More considerations for the public: wiki.creativecommons.org/Considerations_for_licensees

Creative Commons Attribution-NonCommercial 4.0 International Public License

By exercising the Licensed Rights (defined below), You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-NonCommercial 4.0 International Public License ("Public License"). To the extent this Public License may be interpreted as a contract, You are granted the Licensed Rights in consideration of Your acceptance of these terms and conditions, and the Licensor grants You such rights in consideration of benefits the Licensor receives from making the Licensed Material available under these terms and conditions.

Section 1 -- Definitions.

a. Adapted Material means material subject to Copyright and Similar Rights that is derived from or based upon the Licensed Material and in which the Licensed Material is translated, altered, arranged, transformed, or otherwise modified in a manner requiring permission under the Copyright and Similar Rights held by the Licensor. For purposes of this Public License, where the Licensed Material is a musical work, performance, or sound recording, Adapted Material is always produced where the Licensed Material is synched in timed relation with a moving image.

b. Adapter's License means the license You apply to Your Copyright and Similar Rights in Your contributions to Adapted Material in accordance with the terms and conditions of this Public License.

c. Copyright and Similar Rights means copyright and/or similar rights closely related to copyright including, without limitation, performance, broadcast, sound recording, and Sui Generis Database Rights, without regard to how the rights are labeled or categorized. For purposes of this Public License, the rights specified in Section 2(b)(1)-(2) are not Copyright and Similar Rights.

d. Effective Technological Measures means those measures that, in the absence of proper authority, may not be circumvented under laws fulfilling obligations under Article 11 of the WIPO Copyright Treaty adopted on December 20, 1996, and/or similar international agreements.

e. Exceptions and Limitations means fair use, fair dealing, and/or any other exception or limitation to Copyright and Similar Rights that applies to Your use of the Licensed Material.

f. Licensed Material means the artistic or literary work, database, or other material to which the Licensor applied this Public License.

g. Licensed Rights means the rights granted to You subject to the terms and conditions of this Public License, which are limited to all Copyright and Similar Rights that apply to Your use of the Licensed Material and that the Licensor has authority to license.

h. Licensor means the individual(s) or entity(ies) granting rights under this Public License.

i. NonCommercial means not primarily intended for or directed towards commercial advantage or monetary compensation. For purposes of this Public License, the exchange of the Licensed Material for other material subject to Copyright and Similar Rights by digital file-sharing or similar means is NonCommercial provided there is no payment of monetary compensation in connection with the exchange.

j. Share means to provide material to the public by any means or process that requires permission under the Licensed Rights, such as reproduction, public display, public performance, distribution, dissemination, communication, or importation, and to make material available to the public including in ways that members of the public may access the material from a place and at a time individually chosen by them.

k. Sui Generis Database Rights means rights other than copyright resulting from Directive 96/9/EC of the European Parliament and of the Council of 11 March 1996 on the legal protection of databases, as amended and/or succeeded, as well as other essentially equivalent rights anywhere in the world.

l. You means the individual or entity exercising the Licensed Rights under this Public License. Your has a corresponding meaning.

Section 2 -- Scope.

a. License grant.

1. Subject to the terms and conditions of this Public License, the Licensor hereby grants You a worldwide, royalty-free, non-sublicensable, non-exclusive, irrevocable license to exercise the Licensed Rights in the Licensed Material to:

a. reproduce and Share the Licensed Material, in whole or in part, for NonCommercial purposes only; and

b. produce, reproduce, and Share Adapted Material for NonCommercial purposes only.

2. Exceptions and Limitations. For the avoidance of doubt, where Exceptions and Limitations apply to Your use, this Public License does not apply, and You do not need to comply with its terms and conditions.

3. Term. The term of this Public License is specified in Section 6(a).

4. Media and formats; technical modifications allowed. The Licensor authorizes You to exercise the Licensed Rights in all media and formats whether now known or hereafter created, and to make technical modifications necessary to do so. The Licensor waives and/or agrees not to assert any right or authority to forbid You from making technical modifications necessary to exercise the Licensed Rights, including technical modifications necessary to circumvent Effective Technological Measures. For purposes of this Public License, simply making modifications authorized by this Section 2(a) (4) never produces Adapted Material.

5. Downstream recipients.

a. Offer from the Licensor -- Licensed Material. Every recipient of the Licensed Material automatically receives an offer from the Licensor to exercise the Licensed Rights under the terms and conditions of this Public License.

b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.