The microanatomy of Dupuytren's contracture

The palmar fascial ligaments have been examined by microdissection using an operating microscope in fresh and preserved cadaveric hands. The palmar fascia is seen to be a precise three dimensional system of skin ligaments having discreet transverse, longitudinal and vertical fibre systems. In the normal hand there is relative motion between the ligament systems on movement. The longitudinal fibres provide a system of skin anchorage which operates irrespective of the position of the underlying joints and acts particularly to resist shearing forces in gripping. The distribution of the lesions of Dupuytren's Disease has been recorded in a series of clinical cases; nodules, skin pits, distortion of the palmar creases, cords and joint contractures, and the pathogenesis of the disease is related to the anatomy of the palmar ligaments. The disease is described as a process of contracture along anatomical pathways. A hypothesis for the development of Dupuytren's Disease is presented whereby the loss of normal motion between palmar fascial ligaments gives rise on use of the hand to stress concentrations which stimulate fibrous tissue deposition and contracture.