These contributing factors may lead to a more aggressive course of the disease and possibly even an operation at an earlier age. The disease is seen much more frequently in men than in women and has a tendency to usually appear between the ages of 40 and 60. It is a slowly progressive disorder which may have periods of temporary arrest, or even a rapid progression. After the nodules have formed, the tendency is for these to coalesce into a cord, which will lead to a flexion contracture at the MCP joints and the PIP joints. The skin itself can be infiltrated by the disease.
Initial treatment is always non-surgical.
This would consist of continued observation for progression of the problem. As the disease does not involve any pain, there is no reason for the excision of the nodules or cords until contractures in digits have occurred. If a contracture becomes bothersome or a nodule becomes painful, or if the contracture in the MCPJ exceeds 30 degrees or any involvement at the PIP joint occurs, we would recommend surgical excision. This would consist of a palmar and digital fasciectomy utilizing an axillary block anesthetic. A skin graft taken from the forearm is almost always used.