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Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Dupuytren's disease has palmar nodules or bands seen in the mid-palmar aponeurosis, first webspace and fingers producing various degrees of flexion contractures (Figure 3.4). The knuckle pad on the dorsum of the PIP joints causes extension contractures in the fingers. The objective evaluation of the nodules allows accurate assessment of the deformity and improvement needed and achieved by surgery.
The locomotor system
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Palmar fibromatosis (Dupuytren's contracture) begins as a firm nodule in the palm of middle-aged and elderly patients and in time extends to form subcutaneous bands, which produce flexion contractures, especially of the fourth and fifth fingers. Histologically, the palmar aponeurosis is expanded by multiple nodules of proliferating myofibroblasts. In time these nodules become heavily collagenized and poorly cellular. Similar lesions may occur in the sole of the foot, usually without contracture (plantar fibromatosis) or in the penis (Peyronie's disease).
The hand
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Just deep to the palmar skin is the palmar aponeurosis, the embryological remnant of a superficial layer of finger flexors; attachment to the bases of the proximal phalanges explains part of the deformity of Dupuytren’s contracture. Incisions on the palmar surface are also liable to contracture unless they are placed in the line of the skin creases, along the midlateral borders of the fingers or obliquely across the creases.
Extensive high-pressure injection injury of the hand due to epoxy resin paint: a case report
Published in Case Reports in Plastic Surgery and Hand Surgery, 2021
Gaku Niitsuma, Hidechika Nakashima, Takushi Nagai, Kenichirou Teramoto, Keikichi Kawasaki, Katsunori Inagaki
On the first postoperative day, numbness and pain in the fingers had not decreased. Hence, repeat emergency CT was performed, and the retention of additional paint residue was noted, which was more than that anticipated (Figure 4(a,b)). We had to re-perform emergency debridement under axillary nerve block. A skin incision was made from the MP joint of the index finger to the carpal tunnel (as in the first surgery). Hardened-block paint was detected in the subcutaneous tissue, on the palmar aponeurosis, and above the tendon sheaths (Figure 5(a)). In addition, adherent paint was found in the thenar space and around the neurovascular bundles of the fingers. The paint remnants in the thenar space and carpal tunnel had tracked from the injection site (Figure 5(b)). The palmar aponeurosis was excised, and debridement was performed. A suction drain was placed in the carpal tunnel. A dorsal splint was re-applied, which enabled the active range of motion (ROM) of the fingers. The patient received antibiotics intravenously for 1 week (ceftriaxone 2 g/day) after the first and second surgeries.
Patients’ perspectives of collagenase injection or needle fasciotomy and rehabilitation for Dupuytren disease, including hand function and occupational performance
Published in Disability and Rehabilitation, 2023
Madeleine Winberg, Christina Turesson
Dupuytren disease (DD) is a chronic disease affecting the palmar aponeurosis of the hand and leads to cords creating flexion contractures and an inability to extend the finger joints. The ulnar fingers, little and ring finger, are most frequently affected, which impairs the grip function of the hand [1]. The precise aetiology of the disease remains unknown but a strong heredity has been shown and risk factors associated with DD include smoking, diabetes and alcohol consumption [2,3]. The prevalence of DD varies globally between 3% and 42%, and Northern Europe demonstrates a higher rate [1]. The prevalence increases with rising age and DD is more common among males [4], for example in Sweden where 10% of men and 2% of women at the age of 55 years, has the disease [5].
Innervation of the lumbrical and interosseous muscles in hand: analysis of distribution of nerve fascicles and quantification of their surface projections
Published in Journal of Plastic Surgery and Hand Surgery, 2022
There were two layers that required exposure, i.e. a layer superficial to the LMs and a layer deep to the LMs. The skin was incised and reflected distally. After removal of the subcutaneous tissue, palmar aponeurosis, and the arteries, the NFs to the LMs were observed. Then the MN, the tendons of flexor digitorum profundus and flexor digitorum superficialis were cut at the wrist and reflected distally to expose the deep layer. From the origin of the dUN, in the distal and radial direction, the proximal hypothenar muscles were cut and the fat tissue, arteries and adductor pollicis were removed to expose the trunk and branches of the dUN. During dissection, some fascia around the NFs was kept intact to prevent the displacement of fascicles.