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The carpal boss, an unmovable bony protuberance, is located on the dorsum of the wrist at the base of the second and third metacarpals adjacent to the capitate and trapezoid bones. This bony prominence may represent degenerative osteophyte formation and/or the presence of an os styloideum, an accessory ossification center that occurs during embryonic development. When this condition is symptomatic, patients present with complaints of pain and limitation of motion of the affected hand. The symptoms of carpal boss may result from an overlying ganglion or bursitis, an exterior tendon slipping over this bony prominence, or from osteoarthritic changes at this site. Radiographically, the view that best profiles the separate os styloideum is a lateral view utilizing 30 degrees of supination and ulnar deviation of the wrist. Once a diagnosis has been made, treatment can range from the use of nonsteroidal antiinflammatory medication and limited use of the wrist to surgical excision of the anatomic abnormality.

A retrospective study of 169 percutaneous skeletal biopsies performed by radiologists at the Mallinckrodt Institute of Radiology and Barnes Hospital between October 1974 and July 1980 showed an overall accuracy of 94%; a negative result had a predictive value of 92%. A review of the English-language literature revealed that nearly 10,000 aspiration or trephine musculoskeletal biopsies have been reported during the past 50 years; historical accuracy is approximately 80%, but this figure is probably an underestimate because true-negative cases may not have been well documented or tabulated. The authors believe that percutaneous skeletal biopsy should be considered a radiological procedure, and that radiologists could and should perform this procedure as part of a team effort.

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