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Key Features

  • Benign fibrosing disorder of the palmar fascia

  • Contracture of one or more fingers can lead to limited hand function

  • Cause is unknown

  • Occurs primarily in white men older than 50 years. The incidence is higher among alcoholics and patients with chronic systemic disorders (especially cirrhosis)

  • Also associated with systemic fibrosing syndrome, which includes

    • Plantar fibromatosis (10% of patients)

    • Peyronie disease (1–2%)

    • Mediastinal and retroperitoneal fibrosis

    • Riedel struma

Clinical Findings

  • Onset may be acute, but slowly progressive chronic disease is more common

  • Nodular or cord-like thickening of one or both hands, with the fourth and fifth fingers most commonly affected

  • Tightness of the involved digits, with inability to satisfactorily extend the fingers; on occasion, there is tenderness

  • The contracture is well tolerated because it exaggerates the normal position of function of the hand, although resulting cosmetic problems may be unappealing

Diagnosis

  • Clinical findings outlined above

Treatment

  • If the palmar nodule is growing rapidly, injections of triamcinolone or collagenase into the nodule may be of benefit

  • Surgical options include open fasciectomy, partial fasciectomy, or percutaneous needle aponeurotomy and are indicated in patients with significant flexion contractures

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