# Isolated First Web Space Palmar Fibroproliferation in an Avid Pistol Shooter: A Case Report

## TL;DR

A 65-year-old pistol shooter developed a unique hand deformity linked to repetitive shooting, possibly causing fibroproliferation in the palm.

## Contribution

This case report introduces 'pistol shooter’s palm' as a novel, isolated fibroproliferative condition in the first web space of the hand.

## Key findings

- A non-painful, unilateral deformity was observed with a palpable cord in the palmar aponeurosis of the first web space.
- Ultrasound showed asymmetrical thickening of the palmar aponeurosis, leading to a working diagnosis of 'pistol shooter’s palm'.
- The condition was not associated with pain or functional deficits, and surgical intervention was not recommended.

## Abstract

There are various types of contractures of the hand, including diseases of fibroproliferation. However, instances of isolated, atraumatic contractures of the first web space are not well described in the literature. A 65-year-old avid pistol shooter presented to the clinic with a unilateral deformity of his dominant hand. The abnormality developed since he started regularly shooting pistols around one year prior, and it has not caused any pain or functional deficits. There was no relevant medical or family history. On physical examination, the patient exhibited a visible, palpable cord in line with the lateral margin of the palmar aponeurosis. The cord was non-mobile, and differential diagnoses included Dupuytren’s contracture and stenosing tenosynovitis. Ultrasound revealed asymmetrical thickening of the palmar aponeurosis in the first web space, and a descriptive working diagnosis of “pistol shooter’s palm” was considered. The patient was monitored clinically, and surgical intervention was not recommended. The etiology of hand contractures often goes unaccounted for; however, this case describes a potential contributing factor associated with an abnormal presentation of fibroproliferation in the hand.