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Patho-Anatomy of Dupuytren’s

- Discussion:
    - typically involves palmar aponeurosis and digital prolongation (not superficial transverse ligament) in palm;
           - involves lateral digital sheet, Grayson's lig (not Cleland's lig), pretendinous bands, natatory ligament, & spiral 
                 bands in digits;
           - typically digits develop central (pretendinous) & spiral cords;
    - pre-tedinous bands
    - central cord:
         - has no normal fascial precursor;
         - is a continuation of pretendinous cord & lies between the neurovascular bundles;
         - it courses over the middle of the proximal phalanx and attaches distally to bone & tendon sheath over the middle phalanx;
         - nodules may be found at the level of the PIP Joint;
    - pip joint involvement:
    - natatory ligament (superficial palmar transverse ligament)
           - crosses the palm just proximal to the distal palmar crease;
           - does not produce contractures of the digits, although it may contribute to thumb-index web-space contracture;
    - spiral band
           - retrovascular cord:
                 - alone does not often cause PIP Joint contracture;
                 - it is a cause of recurrent contracture, & w/ lateral cord, it contributes to DIP contracture;
    - lateral cord (digital sheet):
         - arises from superficial fascia that surrounds the finger in saggital plane;
         - lateral cord lies lateral to N/V bundle;
         - diseased fibers do not pass dorsally but extend distally and may also cause contracture at the DIP joint;
    - Grayson's ligament