Palmar Fasciitis (PF) is a rare inflammatory condition affecting the deep connective tissue of the hand, known as the palmar fascia. This fibrous tissue is situated beneath the skin of the palm and supports the hand structure. When inflammation occurs, the fascia thickens and stiffens, significantly impairing hand function. Unlike more common hand disorders, PF often presents as part of a broader systemic issue within the body.
Defining Palmar Fasciitis and Symptoms
The palmar fascia is a thin, dense sheet of tissue that anchors the skin and protects deeper structures like nerves and tendons. In Palmar Fasciitis, the tissue undergoes inflammatory and fibrotic changes, leading to thickening and hardening. This loss of elasticity restricts the movement of the hand.
A defining feature of Palmar Fasciitis is the presence of pain and tenderness in the palm, often occurring bilaterally and symmetrically. Patients typically experience a rapid onset of stiffness that makes simple tasks like gripping or fully opening the hand difficult. The inflammation can also lead to the formation of palpable nodules or cords within the palm tissue.
In more progressive forms, the thickening fascia can pull the fingers into a bent position, creating progressive flexion contractures. The rapid development of these contractures, combined with swelling and pain, distinguishes PF from more gradually developing hand conditions. The skin over the palms may also appear taut and thickened, sometimes developing deep creases, a finding referred to as the “groove sign.”
The Link to Systemic Disease
Palmar Fasciitis is frequently considered a secondary manifestation, often signaling an underlying disease affecting the entire body. The most significant association is with a specific paraneoplastic syndrome linked to cancer. This connection is so well-established that the condition is often referred to as Palmar Fasciitis and Polyarthritis Syndrome (PFPAS) when accompanied by joint inflammation.
The condition is most commonly linked to internal malignancies, particularly ovarian carcinoma, though it has also been reported with breast, gastric, pancreatic, and lung adenocarcinoma. PF is not caused by cancer cells metastasizing to the hand but by tumor-released substances, such as cytokines, that circulate and trigger inflammatory changes in the fascia and joints.
The hand symptoms can often precede the diagnosis of the underlying cancer by several months, making recognition of PF an important clue for detecting an occult malignancy. The syndrome is also associated with non-malignant systemic conditions, such as systemic sclerosis, rheumatoid arthritis, and certain infectious diseases. The resolution of the hand symptoms depends entirely on the successful treatment of the primary systemic disease.
Clinical Evaluation and Differential Diagnosis
A physician’s evaluation begins with a thorough physical examination, focusing on the symmetry of the symptoms and the extent of the fascial thickening. The clinician assesses the tenderness of the palms, the presence of nodules or cords, and the range of motion, noting any limitations in finger extension. The rapid and often painful nature of the contractures raises immediate suspicion of Palmar Fasciitis.
Diagnostic imaging, such as high-resolution ultrasound or Magnetic Resonance Imaging (MRI), is typically used to confirm the diagnosis and assess the extent of the fibrosis. These modalities visualize the diffuse thickening of the palmar fascia and help rule out other local causes of hand pain. However, the diagnosis is primarily clinical, based on the characteristic presentation.
It is important to distinguish Palmar Fasciitis from Dupuytren’s Contracture, a much more common condition that also involves the palmar fascia. Dupuytren’s typically develops slowly, is usually painless, and progresses to fixed contractures, often involving the ring and little fingers asymmetrically.
In contrast, Palmar Fasciitis presents more acutely, is generally painful, and affects the hands symmetrically. Key differentiating factors include the presence of significant pain and the bilateral, diffuse nature of the fascial changes, often accompanied by involvement of other joints in the body.
Current Treatment Approaches
The management of Palmar Fasciitis follows a two-pronged approach: treating the local hand symptoms and addressing the underlying systemic cause. Local management aims to reduce inflammation, alleviate pain, and maintain hand function. Physical therapy, involving stretching and mobilization exercises, is a standard component to prevent further stiffness and contracture development.
Pharmacological interventions include non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and local inflammation. Corticosteroid injections directly into the thickened fascia or affected joints may provide temporary relief and reduce the inflammatory component of the syndrome.
For the systemic variant, Palmar Fasciitis and Polyarthritis Syndrome, definitive treatment focuses on controlling the associated malignancy or autoimmune disorder. Successful treatment of the underlying cancer, often through surgery, chemotherapy, or radiation, frequently leads to a significant reduction or complete resolution of the hand symptoms. In cases associated with non-malignant autoimmune disorders, immunosuppressive medications may be used to control the systemic inflammation. Surgical intervention to release contractures is rarely performed for PF, generally reserved for severe, fixed deformities that persist after the systemic cause has been managed.