The Transverse elements of the Palmar Aponeurosis in Dupuytren's Contracture: Their pathological and Surgical Significance

Abstract

Some original observations on the anatomy and pathology of the transverse elements of the palmar aponeurosis are reported. The transverse palmar ligament forms a continuous band, strictly limited to the midpalmar region with deep attachments at each end merging with the paratendinous septa bordering the compartment on the radial and the ulnar sides. Throughout its length the transverse band is intimately related to the underlying paratendinous septa and together they form a well defined fibrous tunnel system. The function of this separate anatomical structure is discussed, and related to observations on hands following its removal. In all stages of Dupuytren's contracture it was noticed that the transverse palmar band was not involved in the pathological process, this being confirmed as a constant feature in more than 300 consecutively operated hands. In marked contrast the transverse fibers of the interdigital ligaments were frequently the site of pathological changes, resulting in contracted bands.In th...