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Prevalence of Palmar Fibromatosis with and without Contracture in Asymptomatic Patients
Gustave Diep, BS; Julie Agel, MA; Julie E. Adams, MD
Department of Orthopaedics, University of Minnesota, Minneapolis, MN

Introduction: Two distinct entities of palmar fibromatosis have been described in the literature: the typical and well-known Dupuytren’s disease, which has a genetic predisposition and commonly results in progressive digital contractures and the more recently described atypical “Non-Dupuytren’s palmar fascial disease”, which is non-progressive and in which genetic predisposition does not seem to be an important contributor to pathogenesis. This current study documents the proportion of hand clinic patients presenting with palmar fibromatosis with and without contracture.

Methods: A retrospective study was performed of all “new” patients > 18 years presenting to a single surgeon’s hand clinic over a 16-month period. Demographics and information regarding presence or absence of palmar fibromatosis, contracture, prior known diagnosis of Dupuytren’s disease, and reason for presentation was abstracted from chart review. The percentage of asymptomatic patients with palmar fibromatosis was calculated.

Results: 827 patients (474 women (57%), 353 men (43%)) were included in the study, and 306 (37%) had palmar fibromatosis. Among all patients, 33% (n=118) of male and 40% (n= 188) of female patients had palmar fibromatosis. Only 26 (8%) had contracture (9 females and 17 males) while 280 (92%) had palmar fibromatosis without contracture. Among those who had contracture, 21 presented with a primary complaint of Dupuytren’s disease (symptomatic contracture). Prevalence of palmar fibromatosis increased with increasing age.

Discussion: Palmar fibromatosis is a common condition (37% of this patients population study) and most patients (92%) with palmar fibromatosis do not have contracture and are asymptomatic; this suggests the possibility that most patients may not go on to develop contractures despite having Dupuytren’s disease. Another possibility would be that the vast majority of these patients (92%) may have non-Dupuytren’s fascial palmar disease, which would explain the absence of contracture. In contrast to prior studies, prevalence of palmar fibromatosis was similar between the genders, although the average age of female patients (50.4 years) was greater than males (46.0 years) as a confounding factor. In addition, there were more symptomatic males (65%) than females (35%), which indicate that although females have the same prevalence of palmar fibromatosis than males, they are also less likely to have contractures.

It is important to recognize that Dupuytren’s palmar fibromatosis is common and often present without overt contractures, since surgical procedures performed for other reasons may worsen the condition and patients should be counseled appropriately.

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