Palmar Bands in Rheumatoid Arthritis and Other Chronic Conditions of the Upper Limb

Abstract

Palmar prolapse of the flexor tendons as a result of attenuation of the A1 and A2 pulleys occurs in rheumatoid arthritis and other conditions in which the joints of the fingers are chronically flexed. The flexor tendons may be palpable and sometimes visible as longitudinal bands crossing the palm. This can lead to confusion with the palmar bands of Dupuytren's disease. These bands are illustrated in a small series of patients and a serious complication of a misdiagnosis of Dupuytren's disease is presented. The pathogenesis of these palmar bands in rheumatoid arthritis is discussed.

Dupuytren Disease

“…Stenosing tenosynovitis without triggering can be associated with thickening and adherence of the skin to the underlying flexor tendon sheath. Prominence of flexor tendons due to attenuation of anular pulleys, as is found in rheumatoid arthritis, can be confused with pretendinous cords 79 . Digital joint flexion deformity DUPUY T R E N DISEASE: ANATOMY, PATHOLOG Y, PRESENTATION, A N D TREATMENT such as that seen following ulnar nerve lesions and posttraumatic contracture also should be differentiated from longstanding Dupuytren disease.…”

Dupuytren’s Disease in a Patient with Marfan’s Syndrome

“…The presence of prominent palmar bands which are not Dupuytren's disease but anteriorly subluxed flexor tendons as a result of chronic metacarpophalangeal joint flexion secondary to rheumatoid disease and mental and neurological conditions, was described by Elliot and Khan (1996). These authors attributed this tendon bowstringing to attenuation of the A1 and A2 pulleys as a result of the chronically flexed finger position.…”

“…Having made this misdiagnosis, the fingers would certainly be released, but by tenotomy, not fasciotomy. Elliot and Khan (1996) drew attention to the sharper feel of the subluxed flexor on palpation, making diagnosis possible if suspicion was present from the patient's associated medical condition. Our patient, with an intrinsic defect in the tissue collagen, presumably weakening the palmar aponeurosis and/or flexor pulley system, exhibited the same clinical sign and would have been equally at risk of flexor tenotomy, resulting in a flail finger, if treated by blind/needle fasciotomy.…”