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Introduction

Lipomas are common, benign soft tissue tumors comprised of fat cells. Depending on their location, lipomas may be asymptomatic or cause significant pain and/or functional impairment. Because they are usually well encapsulated, lipomas can be removed by careful marginal excision.

Related Anatomy

  • Commonly occur subcutaneously or adjacent to nerves or muscles in the hand or forearm

Relevant Basic Science

  • Composed of mature adipocytes arranged in lobules, surrounded by a fibrous capsule

Incidence and Related Conditions

  • Hereditary multiple lipomatosis, adiposis dolorosa, Gardner's syndrome, and Madelung's disease

Differential Diagnosis

  • Ganglion cyst
  • Epidermoid cyst
  • Liposarcoma
  • Metastatic disease
  • Erythema nodosum
  • Weber-Christian panniculitis
  • Sarcoidosis
  • Nodular fasciitis
  • Nodular subcutaneous fat necrosis
  • Vasculitic nodules
  • Rheumatic nodules
  • Infection (eg, onchocerciasis, loiasis)
  • Hematoma
ICD-10 Codes
  • LIPOMA

    Diagnostic Guide Name

    LIPOMA

    ICD 10 Diagnosis, Single Code, Left Code, Right Code and Bilateral Code

    DIAGNOSISSINGLE CODE ONLYLEFTRIGHTBILATERAL (If Available)
    LIPOMA, BENIGN NEOPLASM, ARM D17.22D17.21 

    ICD-10 Reference

    Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208

Clinical Presentation Photos and Related Diagrams
  • Lipoma Proximal Dorsal Forearm with PIN Palsy
    Lipoma Proximal Dorsal Forearm with PIN Palsy
  • Partial PIN Palsy secondary to Lipoma Proximal Dorsal Forearm
    Partial PIN Palsy secondary to Lipoma Proximal Dorsal Forearm
  • Lateral view of lipoma in fingertip
    Lateral view of lipoma in fingertip
  • Palmar view of lipoma in fingertip
    Palmar view of lipoma in fingertip
  • Palpating lipoma in carpal tunnel
    Palpating lipoma in carpal tunnel
Symptoms
Complaining of rubbery, soft, movable mass
Mass is not painful
Mass size may change with changes in weight
Typical History

A patient with a lipoma usually is a middle-aged individual who presents with a mass. Frequently the mass has been present for several months. The mass generally is either painless or has some associated soreness but no night pain. The patient may note that the mass size varies in size with the patient's weight gain or loss.

Positive Tests, Exams or Signs
Work-up Options
Images (X-Ray, MRI, etc.)
Imaging for Lipomas
  • Note the radiolucent mass in the proximal radial forearm. Lipomas frequently appear darker on plain X-ray than the surrounding muscle. This radiographic finding is called a Bufalini Sign.
    Note the radiolucent mass in the proximal radial forearm. Lipomas frequently appear darker on plain X-ray than the surrounding muscle. This radiographic finding is called a Bufalini Sign.
  • MRI of recurrent atypical lipoma of right hand and wrist (Guyon's Canal) with T1 sagittal view  and X-sectional view in insert.  Note MRI of benign and atypical lipomas have a similar appearance
    MRI of recurrent atypical lipoma of right hand and wrist (Guyon's Canal) with T1 sagittal view and X-sectional view in insert. Note MRI of benign and atypical lipomas have a similar appearance
Treatment Options
Conservative
  • Watchful waiting if no pain, not enlarging and not interfering with other structures like nerves
  • Steroid injection
  • Liposuction
Operative
  • Marginal excision including the capsule of the lipoma
Treatment Photos and Diagrams
Surgical Treatment of Benign Lipomas
  • Lipoma with PIN nerve palsy.  Inserts show tip of lipoma in the proximal dorsal forearm and the partial PIN palsy on examination of the finger extension.
    Lipoma with PIN nerve palsy. Inserts show tip of lipoma in the proximal dorsal forearm and the partial PIN palsy on examination of the finger extension.
  • Lipoma with PIN nerve palsy.  The lesion and the PIN (posterior interosseous nerve) have been exposed through a dorsal Thompson approach.
    Lipoma with PIN nerve palsy. The lesion and the PIN (posterior interosseous nerve) have been exposed through a dorsal Thompson approach.
  • Excised lipoma from left long fingertip
    Excised lipoma from left long fingertip
  • Excision of lipoma from the left carpal tunnel
    Excision of lipoma from the left carpal tunnel
Surgical Treatment of Atypical Lipomas
  • Recurrent atypical lipoma has been excised from left wrist and hand.  Excised tumor in the insert. Ulnar artery (1) and ulnar nerve (2) is shown.
    Recurrent atypical lipoma has been excised from left wrist and hand. Excised tumor in the insert. Ulnar artery (1) and ulnar nerve (2) is shown.
CPT Codes for Treatment Options

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Common Procedure Name
Excision subcutaneous mass wrist/forearm (excision lipoma)
CPT Description
Excision tumor, soft tissue of forearm and/or wrist area, subcutaneous, less than 3 cm
CPT Code Number
25075
Common Procedure Name
Excision deep mass wrist/forearm (excision lipoma)
CPT Description
Excision tumor, soft tissue of forearm and/or wrist area, subfascial (e.g. intramuscular), less than 3 cm
CPT Code Number
25076
Common Procedure Name
Excision pyogenic granuloma (rheumatoid nodule, hemangioma)
CPT Description
Excision of benign tumor subcutaneous
CPT Code Number
26115
Common Procedure Name
Excision mass finger (includes glomus tumor and Xanthomas)
CPT Description
Excision of benign tumor; deep, subfascial, intramuscular
CPT Code Number
26116
CPT Code References

The American Medical Association (AMA) and Hand Surgery Resource, LLC have entered into a royalty free agreement which allows Hand Surgery Resource to provide our users with 75 commonly used hand surgery related CPT Codes for educational promises. For procedures associated with this Diagnostic Guide the CPT Codes are provided above. Reference materials for these codes is provided below. If the CPT Codes for the for the procedures associated with this Diagnostic Guide are not listed, then Hand Surgery Resource recommends using the references below to identify the proper CPT Codes.

CPT QuickRef App.  For Apple devices: App Store. For Android devices: Google Play

CPT 2021 Professional Edition: Spiralbound

Complications

Operative:

  • Infection, ecchymosis, hematoma, and/or seroma
  • Nerve injury, artery injury, and/or muscle injury
  • Excessive scarring
  • Recurrence
Outcomes
  • Operative treatments generally provide a cure.
Key Educational Points
  • Benign soft-tissue masses are approximately 200 times more common than malignant ones, lipomas being the most common.
  • Lipomas are usually non-tender, soft, subcutaneous masses.
  • Lipomas should be considered for surgical excision if they enlarge, cause symptoms (pain or numbness from pressue on a nerve) or cause significant cosmetic conderns.
  • The distinction between benign lipomas, atypical lipomas and liposarcoma most be based on histology. 4,5
  • Lipomas that infiltrate muscle have a higher recurrence rate.
  • Atypical lipomas can be treated with marginal excision with an acceptable recurrence rate in the hand and forearm while the prognosis is worse for tumors in the retroperitoneal area.4,5
References

New Articles

  1. Nakamura S, Okazaki M, Tazaki K. A case report of a giant forearm lipoma causing anterior interosseous nerve palsy after fracture of the distal radius. Hand Surg 2014;19(1):109-11.
  2. Elbardouni A, Kharmaz M, Salah Berrada M, et al. Well-circumscribed deep-seated lipomas of the upper extremity. A report of 13 cases. Orthop Traumatol Surg Res 2011;97(2):152-8.
  3. Doyle JR. Tumors. In Tornetta P and Einhorn TA,eds. Orthopaedic Surgery Essentials Hand and Wrist. Philadelphia: Lippincott Wiiliams & Wilkins. 2006:44.
  4. Al-Qattan MM. Conventional and cellular atypical lipomas of the hand and forearm: a report of 9 cases. J Hand Surg Am. 2016; 41(5): e85-e89.
  5. Evans HL. Atypical lipomatous tumour, its variants, and its combined forms. A study of 61 cases, with a minimum follow-up of 10 years. Am J Surg Pathol. 2007; 31(1): 1-14.

Reviews

  1. Tahiri Y, Xu L, Kanevsky J, Luc M. Lipofibromatous hamartoma of the median nerve: a comprehensive review and systematic approach to evaluation, diagnosis, and treatment. J Hand Surg Am 2013;38(10):2055-67.
  2. Gupta A, Singal R, Mittal A, Goyal M. Report of two cases of subcutaneous lipoma over the finger and review of literature: case series: benign tumour. Musculoskelet Surg 2011;95(3):247-9.

Classics

  1. White WL and Hanna DC. Troublesome lipomata of the upper extremity. J Bone Joint Surg Am 1962;44-A:1353-9.
  2. Pozner JN, Canick ML, Ramirez OM. Endoscopically assisted lipoma removal. Plast Reconstr Surg 1996;98(2):376-7.
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