The wrist has numerous described accessory ossicles, the most clinically significant being the os centrale (between the capitate, scaphoid, and trapezoid), the os styloideum (at the base of the second or third metacarpal), and the os Gruberi (adjacent to the triquetrum). Most are incidental radiographic findings that rarely cause symptoms. The os styloideum carpi can cause carpal boss syndrome — a painful dorsal midhand prominence at the second and third CMC joints.
Carpal boss from an os styloideum or osteophyte at the second and third CMC joint dorsal margin produces a firm dorsal midhand mass that is often confused with a ganglion but is non-transilluminatable and non-fluctuant. Ultrasound confirms bony versus cystic nature. Symptomatic cases managed with injection and occasionally surgical excision.
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