Anatomical evidence supports recent hypothesis on the pathogenesis of Dupuytren’s contracture

Abstract

The authors of the article proposed a hypothesis of the origin of Dupuytren's disease. Taking into account their own observations and literature data, they connect the fibro-proliferative thickening and shortening of the fibrous structures of the palmar aponeurosis, which lie on the surface of the flexor tendons and small muscles of the hand, with periodic trauma to the hand and fingers. At the moments of light and even minor injuries (contusion, compression) of the hand, nerve growth factors exit and accumulate in the intercellular spaces of the tissues of the palmar surface of the fingers. Local manifestations of nerve growth factors can activate fibroblast-like cells located near the external capsule of Pacini bodies. Pacini bodies emanating from the sensory nerves of the skin of the fingers represent their neural organelles, which act as receptors for touch and vibration. The local appearance of nerve growth factor can cause the migration and proliferation of these fibroblast-like cells from the external capsule of Pacini bodies. Repeated intermittent even minor (micro) injuries of the hand lead to a process of chronic inflammation involving fibrous structures that surround the tendons (walls of the tendon sheath) on the palmar side of the fingers and hand. The importance of the proximity of the tendons and neurovascular bundles was noted. The article presents schemes based on morphological and radiology (High Resolution MRI) studies. (13 figs, bibliography: 38 refs).