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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
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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
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Corticosteroid injection with a percutaneous needle aponeurotomy has shown some promise
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
Splinting post surgery is beneficial
Compared to placebo, tamoxifen therapy produced moderate evidence of improvement before or after a fasciectomy