Dupuytren fascia key to understanding hand contracture

The word Dupuytren, of course, is the Frenchman’s name who made many discoveries about this condition, and so Dupuytren contracture of the hand was named after him.

The word “fascia” refers to a type of thin but tough fibrous tissue that envelops the body beneath the skin; it covers all muscles, tendons, ligaments and groups of muscles, tendons and ligaments, and surrounds and covers all organs.  Fascia creates spaces within the body that serve as passageways and supports for blood vessels, nerves, lymph vessels and organs.  It also helps provide a tough gripping surface for the hand and fingers. It is easy to understand fascia if you think of it as being like a clear plastic wrap (Saran wrap) that covers and separates most everything inside the body.

The palm side of the hand contains many nerves, tendons, muscles and ligaments that are involved in performing all of the wonderful things hands can do.  All of these are covered, surrounded, and held in functional groups by fascia.

With this in mind, you will understand that the Dupuytren fascia is the tissue inside the palm of the hand that is affected in Dupuytren contracture.  It is the thickened and central portion of the soft tissue below the palm of the hand that surround the muscles, ligaments, tendons and blood vessels; it travels upward toward the base of each finger after originating from the tendon of the palmaris longus muscle at the wrist, and has a somewhat triangular shape.  This fascia serves to prevent injury by not allowing the fingers to bend too far backward, and it surrounds each finger by dividing into thin bands of tissue at the fingers to reinforce the joints and bones.

Fascia makes up the aponeurosis of the hand 

Another important term that appears often when reading about Dupuytren’s contracture is “aponeurosis.”  An aponeurosis is a large flat sheetlike  membrane of strong fascia that resembles a flattened tendon, and it serves to connect a muscle to the part that it moves.   In the case of Dupuytren contracture, the muscle that does moving is the palmaris longus muscle located in the forearm and the aponeurosis of that muscle moves the four fingers; the aponeurosis of the palmaris longus muscle is found in the palm of the hand.  When that aponeurosis is operated on with a needle to tear and weaken it, it is called a needle aponeurotomy.

Dupuytren contracture typically first appears as a thick lump, nodule or short cord in the palm of the hand, just below the ring finger or perhaps the little finger.  Over time more nodules form as the palmar tissues thicken and shorten.  This causes the involved fingers to be pulled down toward the palm, preventing full straightening.   If the contracture of the Dupuytren fascia advances to one or more joints of the involved fingers, they can be locked in a permanent flexion, causing a drastically reduced usefulness of the hand.

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