Features of palmar fasciitis syndrome
Palmar fasciitis syndrome (aka palmar fibromatosis) is almost uniformly associated with ovarian carcinoma, although it can be seen with other malignancies (breast, stomach, pancreas, lung, and colon). It is characterized by progressive, symmetric contractures of the digits, palmar fascia fibrosis, pain, and vasomotor instability similar to complex regional pain syndrome (CRPS). A symmetric polyarthritis can accompany the fibrosis. Progressive changes lead to a “woody hands” texture and appearance. The presence of palmar fasciitis portends a poor prognosis because it typically manifests after tumor metastasis. Plantar fasciitis with lower extremity involvement can occur in some cases.
Histologic examination of the involved tissues reveals extensive fibrosis with increased fibroblast and mononuclear cell infiltration. There is no evidence of collagen deposition. Deposits of IgG in the palmar fascia and the presence of low-titer ANAs in some patients suggest an immunopathologic mechanism. Treatment response with chemotherapy, NSAIDs, corticosteroids, ganglionic blockade, and/or physical therapy is usually poor. Successful removal of the underlying tumor may result in dramatic clinical improvement of the palmar fasciitis syndrome.
