Soft-tissue masses located at the hand and wrist are a frequent clinical presentation. The majority of these are ganglia, which have characteristic imaging features. Other common masses in which a diagnosis is suggested by imaging include hemangiomas, lipomas, and focal synovitis. The remainder are rare although a diagnosis may be attempted by considering the patients' age and the location. We reviewed 39 soft-tissue masses at the hand and wrist referred to our institution between September 1998 and January 2006 that had indeterminate imaging features. The majority were benign neoplastic lesions with the most common being a giant cell tumor of the tendon sheath, followed by angioleiomyoma, peripheral nerve sheath tumor, fibromatosis, fibroma of tendon sheath, and solitary fibrous tumor. These lesions tend to occur in young adults at the metacarpal level. However, there are no imaging features that can reliably differentiate between benign and malignant tumors.