The MCP joints and wrists are usually spared in erosive osteoarthritis. Unlike in RA, 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 condition 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 worsens, and the hand becomes arched. Treatment Treatment, if during the incipient phase, includes local injection of a corticosteroid suspension into the nodule, which helps local tenderness and possibly delays progression of fibrotic changes. 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. Excision of the diseased fascia must be meticulous because it surrounds neurovascular bundles and tendons.