Branching pretendinous cord anatomic variant of Dupuytren disease: A case report
Background: Dupuytren disease is the result of a pathologic proliferation of myofibroblasts leading to the formation of dense nodules and eventually palpable cords over the palmar aspect of the hand. These cords have typical anatomic relationships in the palm and fingers and can distort local anatom...
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| Format: | Article |
| Language: | English |
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Elsevier
2024-06-01
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| Series: | Journal of Orthopaedic Reports |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773157X23001583 |
| _version_ | 1797435736727748608 |
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| author | Richard McKinney Aaron Rubinstein Steven Regal |
| author_facet | Richard McKinney Aaron Rubinstein Steven Regal |
| author_sort | Richard McKinney |
| collection | DOAJ |
| description | Background: Dupuytren disease is the result of a pathologic proliferation of myofibroblasts leading to the formation of dense nodules and eventually palpable cords over the palmar aspect of the hand. These cords have typical anatomic relationships in the palm and fingers and can distort local anatomy, leading to potential iatrogenic injury during surgical treatment. We report a case of a single pretendinous cord that branches into central cords of two individual fingers. Case report: A 75 year old male presents with painful contractures of the left hand involving the middle and ring fingers. A single pretendinous cord originates at the mid palm along the ring finger metacarpal and branches to the ulnar long finger and radial ring finger. The neurovascular bundles were identified in close proximity to the pathologic tissues but did not form true spiral nerve complexes. Literature review: Classic anatomic relationships for pretendinous, central, and spiral cords are well described in the literature. To our knowledge, this is the first reported case of this branching pattern to separate digits, although other branching patterns to the same digit have been previously described. Clinical relevance: The common and proper digital neurovascular bundles can be put at increased risk of injury in the surgical management of Dupuytren disease, especially in the setting of unexpected anatomic variants. It is paramount that surgeons remain vigilant in the unpredictable setting of these pathologic structures and strict adherence to their careful dissection and resection should be stressed. |
| first_indexed | 2024-03-09T10:52:34Z |
| format | Article |
| id | doaj.art-93aff0eae4e14932a0167d2de72c5e9c |
| institution | Directory Open Access Journal |
| issn | 2773-157X |
| language | English |
| last_indexed | 2024-03-09T10:52:34Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Orthopaedic Reports |
| spelling | doaj.art-93aff0eae4e14932a0167d2de72c5e9c2023-12-01T05:03:20ZengElsevierJournal of Orthopaedic Reports2773-157X2024-06-0132100286Branching pretendinous cord anatomic variant of Dupuytren disease: A case reportRichard McKinney0Aaron Rubinstein1Steven Regal2Corresponding author. 1307 Federal Street, 2nd floor, Pittsburgh, PA, 15212, USA.; Allegheny Health Network, Department of Orthopaedic Surgery, Hand and Upper Extremity Division, 1307 Federal Street, 2nd floor, Pittsburgh, PA, 15212, USAAllegheny Health Network, Department of Orthopaedic Surgery, Hand and Upper Extremity Division, 1307 Federal Street, 2nd floor, Pittsburgh, PA, 15212, USAAllegheny Health Network, Department of Orthopaedic Surgery, Hand and Upper Extremity Division, 1307 Federal Street, 2nd floor, Pittsburgh, PA, 15212, USABackground: Dupuytren disease is the result of a pathologic proliferation of myofibroblasts leading to the formation of dense nodules and eventually palpable cords over the palmar aspect of the hand. These cords have typical anatomic relationships in the palm and fingers and can distort local anatomy, leading to potential iatrogenic injury during surgical treatment. We report a case of a single pretendinous cord that branches into central cords of two individual fingers. Case report: A 75 year old male presents with painful contractures of the left hand involving the middle and ring fingers. A single pretendinous cord originates at the mid palm along the ring finger metacarpal and branches to the ulnar long finger and radial ring finger. The neurovascular bundles were identified in close proximity to the pathologic tissues but did not form true spiral nerve complexes. Literature review: Classic anatomic relationships for pretendinous, central, and spiral cords are well described in the literature. To our knowledge, this is the first reported case of this branching pattern to separate digits, although other branching patterns to the same digit have been previously described. Clinical relevance: The common and proper digital neurovascular bundles can be put at increased risk of injury in the surgical management of Dupuytren disease, especially in the setting of unexpected anatomic variants. It is paramount that surgeons remain vigilant in the unpredictable setting of these pathologic structures and strict adherence to their careful dissection and resection should be stressed.http://www.sciencedirect.com/science/article/pii/S2773157X23001583 |
| spellingShingle | Richard McKinney Aaron Rubinstein Steven Regal Branching pretendinous cord anatomic variant of Dupuytren disease: A case report Journal of Orthopaedic Reports |
| title | Branching pretendinous cord anatomic variant of Dupuytren disease: A case report |
| title_full | Branching pretendinous cord anatomic variant of Dupuytren disease: A case report |
| title_fullStr | Branching pretendinous cord anatomic variant of Dupuytren disease: A case report |
| title_full_unstemmed | Branching pretendinous cord anatomic variant of Dupuytren disease: A case report |
| title_short | Branching pretendinous cord anatomic variant of Dupuytren disease: A case report |
| title_sort | branching pretendinous cord anatomic variant of dupuytren disease a case report |
| url | http://www.sciencedirect.com/science/article/pii/S2773157X23001583 |
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