Erosive OA does not usually affect the MCP joints or wrists. The ESR and CBC are usually normal, regardless of disease severity. Progressive contracture of the palmar fascial bands, producing flexion deformities of the fingers. This autosomal dominant disorder with variable penetrance occurs more commonly in patients with diabetes, alcoholism, or epilepsy. However, the factor that causes the palmar fascia to thicken and contract is unknown.
Some cases are familial.
The nodule may initially cause discomfort but becomes painless as it matures. Eventually, the contracture may worsen, and the hand can become arched. Treatment During the incipient phase, local injection of a corticosteroid suspension into the nodule may delay fibrous thickening. Surgery is usually indicated when the hand cannot be placed flat on a table or when significant contracture develops at the PIP joints, limiting hand function. The PIP joints are particularly recalcitrant to correction, and early surgery is advised when PIP joint contracture occurs.