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Pre-Tendinous Cord

- Discussion:
    - arises from thickening and contracture of pretendinous bands:
    - inserts into skin distal to MP joint & into tendon sheath does not cause N/V displacement, but is responsible for MP
           flexion deformities which can be predictably corrected by surgical excision;
    - at a point just distal to the superficial transverse palmar ligament (which is just proximal to the metacarpal heads), the 
         pretendinous cord bifurcates to form the spiral bands;

- Surgical Excision:
    - transverse incision is made across exposed offending pre-tendinous is released into extension;
    - N/V bundle is well protected at this level, lying dorsal to palmar fascia;
          - skin fixation to palmar & digital fascia & nodules makes dissection in distal part of palm, esp in digit, hazardous, for NV bundle may lie
                  either superficial or deep to the diseased fascia;
          - in little finger, ulnar palmar digital nerve should be isolated proximally over muscle belly of the abductor digiti quinti and progressively 
                  dissected free from the diseased fascia