Surgical Management of Unilateral Soft Tissue Swelling around the Proximal Interphalangeal Joint in an Adolescent: A Case Report of Pachydermodactyly.

Naoki Kato,Mamoru Niitsu,Keizo Fukumoto,Tetsuya Kawabe,Eiichi Arai

doi:10.1155/2015/242078

Naoki Kato, Mamoru Niitsu + Show 3 more

Open Access

https://doi.org/10.1155/2015/242078

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Abstract

Pachydermodactyly (PDD) is a rare and benign acquired form of digital fibromatosis, characterized by asymptomatic fusiform soft tissue hypertrophy of the lateral aspect of the proximal interphalangeal (PIP) joints of the fingers. The etiology of PDD remains unknown, but it usually affects healthy males around the age of puberty. It can be misdiagnosed as inflammatory rheumatic diseases, especially as juvenile chronic arthritis. Here, we report a case of PDD in an 18-year-old man who had progressive fusiform swelling of the PIP joint on his left middle finger. Although he had no pain or functional limitation of movement, he chose to undergo surgical resection of the lesion to obtain a conclusive diagnosis and to rectify the deformity's appearance. Histologically, the lesion was characterized by coarse fibrosis in the adipose tissue, peripheral nerve fibers, and eccrine glands; this is compatible with a diagnosis of PDD.

Highlights

(PDD), from the Greek words pachy, dermo, and dactylos, was first reported by Bazex et al in 1973 [1]
An 18-year-old man presented at our hospital with asymptomatic, gradually increasing fusiform swelling of the proximal interphalangeal (PIP) joint in his left middle finger
Plain radiographs of the hands revealed fusiform soft tissue swelling without joint space narrowing in the PIP joint of the middle finger

Summary

Introduction

(PDD), from the Greek words pachy (thick), dermo (skin), and dactylos (finger), was first reported by Bazex et al in 1973 [1]. PDD is a benign, asymptomatic thickening of the soft tissues that overlie the radial and ulnar aspects of the proximal interphalangeal (PIP) joints but does not produce any fundamental damage to the joint structures. Some authors believe the cause to be repetitive, exogenous, minor traumas due to habitual or compulsive habits of rubbing of fingers [1,2,3,4]. In the field of orthopedic surgery, only one case report treated with tranilast has been published recently [5]. We report a case of successful surgical management of PDD in an 18-year-old man who showed progressive lateral swelling of the PIP joint in the unilateral middle finger

Case Report

Discussion