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Clinical Evaluation
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The superficial palmar fascia is triangular in shape and lies in the coronal plane of the palm. The apex of the triangle contains the transverse carpal ligament and terminal fibres of the palmaris longus tendon. The apex is confluent, and the base is divergent lying under the transverse retinacular ligament. There are four central bands (pretendinous bands) which originate from the apex and extend distally to each finger except the thumb. The base is wide, and all these four bands are bridged by a superficial transverse palmar ligament. This ligament continues as proximal first webspace ligament along the radial border of the index central band reaching to the radial sesamoid of the thumb MCP joint (Figure 2.21).
Surgery of the Peripheral Nerve
Published in Timothy W R Briggs, Jonathan Miles, William Aston, Heledd Havard, Daud TS Chou, Operative Orthopaedics, 2020
Ravikiran Shenoy, Gorav Datta, Max Horowitz, Mike Fox
The exposure continues in line with the skin incision until the superficial palmar fascia is exposed deep to subcutaneous fat. Occasionally, the belly of flexor pollicis brevis (FPB) is superficial to the fascia and is divided. The fibres of the superficial palmar fascia are incised in the same line.
Dupuytren's Contracture
Published in K. Gupta, P. Carmichael, A. Zumla, 100 Short Cases for the MRCP, 2020
K. Gupta, P. Carmichael, A. Zumla
Also make sure you examine both hands. The condition may be limited to one hand or may affect both hands. Early Dupuytren's contracture may be easily missed and it is better felt than seen. So palpate the palmar fascia.
Vibrotactile perception in Dupuytren disease
Published in Journal of Plastic Surgery and Hand Surgery, 2021
Tiffany L. Held, Mahdi Ahmadi, Rajesh Rajamani, Victor H. Barocas, Amy T. Moeller
Dupuytren disease (DD) is a progressive fibroproliferative disorder of the palmar fascia with characteristic nodules and cords. Its incidence has been estimated at approximately 3 cases per 10,000 adults [1], with higher prevalence in individuals of Scandinavian descent [2]. Fibroblasts proliferate and differentiate into myofibroblasts, which produce collagen and exhibit higher contractility, leading to progressive shortening and contraction of the cords [3]. The disease usually presents clinically after age 50, and the ring finger is most commonly affected [2]. Progression of DD is divided into three grades: Grade 1 has a thickened nodule and/or band in the palmar aponeurosis but no discernable contracture; Grade 2 presents as permanent contracture with flexion angle less than 60°; and Grade 3 has flexion greater than 60° [4]. The progression is highly variable and unpredictable [5]. The etiology is unknown, and, although there is a strong genetic component, there is currently no genetic test for DD [3]. Available treatments include fasciectomy [6], needle aponeurotomy [7], collagenase injections [8], and radiation [9].
Angiotensin receptors in Dupuytren’s disease: a target for pharmacological treatment?
Published in Journal of Plastic Surgery and Hand Surgery, 2018
Christopher Stephen, Leila Touil, Partha Vaiude, Jaipaul Singh, Stuart McKirdy
Dupuytren’s disease is an acquired condition of the hand associated with progressive fibrosis and contraction of the palmar fascia, leading to loss of function and significant morbidity. Although first described in 1831, the condition is not yet fully understood. The current mainstay of treatment is surgical; however, the progressive nature of the disease means that surgery cannot be regarded as curative, and so prevention of recurrence remains a major challenge. Therefore, much interest exists in developing therapies to prevent or slow disease progression. To this end, several pharmacological agents have been trialled, including calcium channel blockers, verapamil, azathioprine, procarbazine, prostaglandin E, γ-interferon, and corticosteroids [1], without success. In the present study, we aim to explore the basis for using an anti-fibrotic agent, ACE inhibitors, in this disease.
Palmaris longus interposition in revision surgery for recurrent and persistent carpal tunnel syndrome: a case series
Published in Journal of Plastic Surgery and Hand Surgery, 2020
Pepijn Olivier Sun, Maxime Victorine Pauline Schyns, Erik Taco Walbeehm
All patients underwent extended open CTR. The previous incision is always used and extended proximally with approximately 4 cm, with a break of the incision at the wrist in ulnar direction. Subsequently, the forearm fascia is opened proximally on one side of the palmaris longus (PL) tendon, depending on where the previous incision was placed. The median nerve is released in the forearm (if necessary), and only when the nerve is seen, the dissection is continued distally. Next, the palmar fascia is incised, again depending on the previous incision and the flexor retinaculum can then be easily transected again, from proximal to distal (Figure 1). The release should be completed distally. Subsequently, the PL tendon is released from its compartment in the forearm fascia, leaving the epitenon around the tendon intact. The tendon is transected sufficiently proximal to reach the end of the carpal tunnel when flipped distally (Figure 2). The tendon is then sutured between the two edges of the flexor retinaculum with Vicryl 4-0, with three to four sutures on each side of the retinaculum (Figure 3). As this lengthens the flexor retinaculum, it should increase the volume in the carpal tunnel. Sutures are placed on the outside of the carpal tunnel to avoid contact with the median nerve. In addition, the epitenon is left in place with hope of diminishing adhesions. The skin is closed with Ethilon 4-0. A slight volar cock-up Plaster of Paris is applied directly postoperatively, and the wrist is immobilized for three weeks. Patients are referred to the hand therapists for finger exercises initially and nerve gliding and range of motion exercises following the three weeks of immobilization.