palmaraponeurosen

Palmaraponeuroses denote fibromatoses of the palmar aponeurosis, the fibrous tissue in the palm that protects underlying structures and aids grip. The best known disorder in this group is Dupuytren's contracture, a progressive fibrosis of the palmar fascia that leads to contractures of one or more fingers, most often the ring and little fingers.

Pathophysiology typically involves proliferation and involution of myofibroblasts within the palmar fascia, forming nodules and cord-like bands that shorten and stiffen the tissue. This results in flexion deformities at the metacarpophalangeal and proximal interphalangeal joints. Palmaraponeuroses can be part of a spectrum that includes other fibromatoses in connective tissues, and may be associated with other fibromatoses in different sites.

Epidemiology shows a higher incidence in men, usually presenting in middle age or later, with a greater prevalence among individuals of Northern European descent. Risk factors include family history, diabetes, epilepsy, alcohol consumption, smoking, and certain hand injuries or repetitive stress.

Clinically, patients develop nodules on the palm that may be painful or tender, followed by progressing cords and flexion contractures. Diagnosis is primarily clinical; imaging (ultrasound or MRI) can assess extent when surgery is planned and help differentiate from other hand conditions.

Treatment ranges from observation in mild, non-deforming disease to interventions for functional impairment. Options include enzymatic fasciotomy with collagenase, percutaneous needle fasciotomy, or open fasciectomy. Radiotherapy has been used in some cases to slow progression. Recurrence after treatment is common, and management is tailored to severity and patient needs.