A hand flexion contracture with progression.

A 65 year old male retired farmer presented with an inability to fully straighten the ring finger and little finger of his right hand. This had progressed over the past two years and he had recently noticed a “rope like” swelling in his palm. He had no history of trauma and no medical history of note, except that he had smoked until 10 years earlier and had a 90 pack year history. His father had a similar deformity. Examination showed palpable cords to his middle, ring, and little fingers. He had palpable nodules on the volar aspect of all proximal phalanges, which caused flexion contractures of the proximal interphalangeal joints. The cord and nodules in the ring finger were adherent to the overlying skin. The most severe flexion contractures were seen in the ring finger, with 25° and 36° contractures of the metacarpophalangeal joints and proximal interphalangeal joints, respectively (fig 1).