Malsagova, A.T. (2012) M. Dupuytren: The cutaneous ligaments of the palmodigital junction of the hand. thesis, Medicine.
Full text available on request.Abstract
Introduction: Dupuytren’s Disease (DD) is a fibroproliferative disease of the normal palmar and digital fascia of the hand, resulting in the formation of fibrous cords. Although this is a benign disease, the fibrous cords can give rise to disabling flexion deformities of the fingers, sometimes necessitating amputation in the advanced stages. Although the normal microanatomy of the fascial structures of the hand is essential to the understanding of DD’s progression and its treatment, the literature in unequivocal especially where it concerns the transition of the palmar fascia into the digital fascia. The aim of this study was therefore to elucidate the microanatomy of the palmodigital junction and its relation to palmar and digital fascial structures. Methods: To this end we performed a literature and a dissection study. We dissected a total number of 26 cadaveric digits, 13 middle fingers and 13 ring fingers from 13 fresh frozen human cadaveric hands. A longitudinal midline incision was used on the volar aspect of the hand, running from the midpalm to the tip of the finger. The characteristics of the palmodigital structures were observed and their interrelations with palmar and digtal structures. The proximal and distal borders of the palmodigital fibrous condensations were measured and their width in the midline of the finger at origin and radially and ulnarly. Results: At the palmodigital junction we found a structure which to our knowledge has not been described before. This structure spirals around the neurovascular bundle at the palmodigital junction and we therefore suggest to call it the palmodigital spiralling sheet (PSS). The proximal border fibres of PSS originate from the pretendinous band and insert into the natatory ligament (NL). The intermediate fibres originate from the flexor tendon sheath over the A1 pulley and continue as Grayson’s fibres. The distal border fibres originate from the flexor tendon sheath just distal to the proximal border of the A2 pulley and arch into Cleland’s 1B ligament while it attaches on the flexor tendon sheath at the proximal interphalangeal joint. PSS forms the most proximal and inner part of the neurovascular tunnel. Additionally three types of continuities between volar and dorsal fibres in the digit have been found, possibly contributing to a spiralling arrangement of fibres in the neurovascular tunnel. Conclusion: This study has provided new insights in the microanatomy of the palmar, digital and especially the palmodigital fascia of the hand. The palmodigital spiralling sheet at the palmodigital junction has been found to have an important linking function between the palmar and the digital fascia. PSS and the continuities found between fibres in the digit make the fascia of the palm and digit an intertwining continuum of fibres, instead of separate anatomical structures. Therefore any part of this continuum has the potential of becoming pathologic in DD.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Under the supervison of and Werker, P.M.N. M.D. Ph.D and Zwanenbrug, R.L. drs. |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:42 |
| Last Modified: | 25 Jun 2020 10:42 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/393 |
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