Grayson Ligament: A Revised Description of its Anatomy and Function

Area of Science:

• Anatomy
• Microsurgery
• Hand Surgery

Background:

• The Grayson ligament is implicated in Dupuytren disease contractures.
• Existing anatomical descriptions of the Grayson ligament are inconsistent.

Purpose of the Study:

• To re-examine the anatomy of the Grayson ligament using microsurgical dissection.
• To investigate the dynamic behavior of the Grayson ligament during finger flexion and extension.

Main Methods:

• Microsurgical dissection of 20 fresh-frozen digits.
• Dissection of Thiel-preserved hands to observe dynamic changes.
• Analysis of fiber orientation and relationship to neurovascular bundles.

Main Results:

• The Grayson ligament is part of a trabecular fiber network originating from the flexor tendon sheath.
• Fibers insert into the skin volar to the neurovascular bundle.
• Fibers exhibit a chevron shape in extension and become more transverse in flexion.

Conclusions:

• The Grayson ligament is a dynamic fiber network, not a distinct ligament.
• This network stabilizes the skin and fat pad during extension and allows adaptation during flexion.
• Insights into this anatomy are relevant for understanding Dupuytren disease pathology.