A 58-year-old gardener presents in the surgery with a respiratory infection. While he is consulting, he mentions that he has noticed a hard lump on the palm of his right hand that has been present for several months. It is painless and is not affecting the function of his hand but he is interested to know the diagnosis.
He is hypertensive, his BP being well controlled on an ACE inhibitor and a diuretic, but is otherwise normally well.
On examination, there is a hard fibrous nodular band at the base of his ring finger. He has full movement of his fingers.
What is the diagnosis, differential diagnosis and management?
Diagnosis and management
The diagnosis is Dupuytren’s contracture or palmar fascial fibromatosis. There is thickening of the palmar fascia causing a cord-like band to form on the palm of the hand. It is painless and in the early stages may cause no problem. In more extreme cases, it may cause shortening of the tendon to the finger and the finger to become permanently flexed with resultant loss of movement and function. It is more common in men and in middle- and old-age, and is said to affect one in six men over the age of 65 years. It commonly affects the ring finger but may then progress to involve the fifth and then middle finger. The cause is unknown but may be genetic. It is more common in diabetes and epilepsy.
No treatment is required if the contracture is asymptomatic, but if it is causing loss of function then the patient may be referred for needle fasciotomy or palmar fasciectomy.
Possible different diagnoses
- Trigger finger.
- Intrinsic joint disease.
- Flexor digital tenosynovitis.
- The finger may lock or trigger with a snap.
- Common in patients with rheumatoid arthritis and diabetes.
Contributed by Dr Gwen Lewis, a GP in Windsor, Berkshire