Prediction of the spiral nerve in Dupuytren's contracture

doi:10.1016/S0363-5023(82)80020-8

The Journal of Hand Surgery

Volume 7, Issue 1, January 1982, Pages 84-86

https://doi.org/10.1016/S0363-5023(82)80020-8 Get rights and content

Spiral displacement of the digital nerve occurs because of contracture of diseased fascia. In 90% of cases, this spiral course of the nerve can be predicted preoperatively by the presence of a mass of soft pulpy compressible skin overlying the displaced nerve.

References (5)

G Dupuytren
H Stack
The palmar fascia and the development of deformities and displacements in Dupuytren's contracture
Ann Royal Coll Surg Engl
(1970)

There are more references available in the full text version of this article.

Cited by (23)

Dupuytren Disease
2021, Plastic Surgery - Principles and Practice
Dupuytren disease is an incurable fibromatosis of the palmar fascias of the hand with variable phenotype and disease course. Abnormal myofibroblast activity leads to the formation of nodules, skin pits, and cords that once contracting often cause flexion and adduction contractions, hampering normal hand use. It affects predominantly males of North-Western European descent of over 50 years of age. It is a polygenetic disease, which expression is probably also influenced by environment factors. Treatment is mostly symptomatic and primarily indicated for the correction of progressive finger flexion deformities, and can be operative or nonoperative.
Surgical options are percutaneous or open fasciotomy, segmental or limited fasciectomy, or dermofasciectomy, and each has its indications, which may overlap. Skin defects can be closed by skin grafts or flaps, or – especially when in the palm – can be left to heal secondarily. The ability to correct deformities is quite similar amongst the surgical options. The invasiveness of surgical treatment shows a direct relation with the reconvalescence time and an inverse relation to the durability of the result.
Nonsurgical methods include injection of steroids for nodules or collagenase for cords, and radiotherapy for nodules. The efficacy and durability of collagenase resembles that of percutaneous fasciotomy.
This chapter gives an overview of the current knowledge on this subject.
Fasciectomy for Dupuytren Contracture
2018, Hand Clinics
Citation Excerpt :
When present, these are not divided until the neurovascular structures are identified, because within these tissues, the rare occurrence of a nerve spiraling the cord might be found. The authors identify the nerve in front of the Cleland ligament and behind the Grayson ligament at the PIP joint and follow it proximally to ensure identification of a nerve, which spirals the cord.22 The neurovascular structures are dissected on their lateral side rather than their medial side to avoid damaging branches from the vessels and nerve to the vincula longa.
Ultrasonographic evaluation of displaced neurovascular bundle in dupuytren disease
2013, Journal of Hand Surgery
Citation Excerpt :
This alternative method was possible with standard color Doppler ultrasound without high-frequency probe or high-resolution ultrasound. Although Short and Watson9 reported that the spiral cord could be predicted with high sensitivity and specificity by the presence of redundant pulpy tissue in the distal palm, expertise may be required to judge accurately in confusing cases. We believe preoperative ultrasonography in conjunction with physical examination would be useful.
Neurovascular injury is a serious complication after surgery for Dupuytren disease. The purpose of this study was to evaluate the relationship between the cord and the neurovascular bundle ultrasonographically.
We included 22 healthy volunteers and 14 Dupuytren disease patients (25 fingers) in this study. We evaluated the cord and the digital artery with high-resolution ultrasound. We first investigated the effect of the angle of metacarpophalangeal joint on the position of the radial and ulnar digital arteries in volunteers without evidence of Dupuytren disease. We compared 3 parameters of the radial and ulnar digital arteries, including differences in depth, differences in lateral shift, and the shape of the cross-section of the artery, between volunteers and patients with Dupuytren disease.
None of these parameters changed with flexion of the metacarpophalangeal joint of 0°, 30°, and 60°. Digital arteries and cords could be identified ultrasonographically in all patients, and we confirmed ultrasonographic findings by operative findings in 13 fingers. We classified the fingers into 3 subgroups based on the ultrasonographic findings: type A (n = 13), in which the cord was above the artery; type B (n = 5), in which the cord was below the artery; and type C (n = 7), in which the cord was located between the radial and ulnar digital arteries. Types A, B, and C corresponded to natatory cord/abductor digiti minimi cord, spiral cord, and central cord, respectively. Comparisons among volunteers and patient subgroups showed that the difference in depth in type B patients was significantly larger than that of the other groups. When we set the cutoff point of the difference in depth to 3 mm, sensitivity and specificity to detect the spiral cord were 80% and 76%, respectively.
The relationship between the neurovascular bundle and the type of Dupuytren disease cord can be evaluated by high-resolution ultrasound.
Diagnostic III.
Percutaneous fasciotomy for Dupuytren's contracture
2011, Journal of Hand Surgery
Citation Excerpt :
Dimples are evaluated with a small probe to avoid portals that might transect a dimple sinus or cause pain from contacting the dermis at the depths of the dimple (Fig. 1). Doppler examination (Fig. 3) should be performed when there is a question of a spiral cord, based on soft tissue prominence in the distal palm or proximal digit.7 Spiral cords are marked with a surgical marking pen.
Percutaneous needle fasciotomy in dupuytren's disease
2006, Journal of Hand Surgery
The aim of this study was to examine our results of 74 percutaneous needle fasciotomies for Dupuytren's contracture. Pre-operative and postoperative total passive extension deficit was measured. Patients were seen at the outpatient clinic at 32 months for final follow-up. Extension deficit and sensibility were measured and flexor tendon function assessed. Recurrence, defined as an increase of the passive extension deficit of 30° or more compared to the immediate postoperative measurement, and other complications were also noted. Immediate outcome was excellent with an average improvement of 77%. After 32 months, we reviewed 55 rays. Their recurrence rate was 65%. Two patients experienced a slightly diminished sensibility on one side of the finger. There were no flexor tendon injuries. This procedure has a good short-term effect. It may be suitable for patients who want a minimally invasive treatment and to whom long-term results are less important. It may also have a place in delaying fasciectomy.
Dupuytren's Disease
2005, Core Knowledge in Orthopaedics: Hand, Elbow, and Shoulder

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Prediction of the spiral nerve in Dupuytren's contracture

The palmar fascia and the development of deformities and displacements in Dupuytren's contracture

Ann Royal Coll Surg Engl