Branching pretendinous cord anatomic variant of Dupuytren disease: A case report

Background: Dupuytren disease is the result of a pathologic proliferation of myofibroblasts leading to the formation of dense nodules and eventually palpable cords over the palmar aspect of the hand. These cords have typical anatomic relationships in the palm and fingers and can distort local anatomy, leading to potential iatrogenic injury during surgical treatment. We report a case of a single pretendinous cord that branches into central cords of two individual fingers. Case report: A 75 year old male presents with painful contractures of the left hand involving the middle and ring fingers. A single pretendinous cord originates at the mid palm along the ring finger metacarpal and branches to the ulnar long finger and radial ring finger. The neurovascular bundles were identified in close proximity to the pathologic tissues but did not form true spiral nerve complexes. Literature review: Classic anatomic relationships for pretendinous, central, and spiral cords are well described in the literature. To our knowledge, this is the first reported case of this branching pattern to separate digits, although other branching patterns to the same digit have been previously described. Clinical relevance: The common and proper digital neurovascular bundles can be put at increased risk of injury in the surgical management of Dupuytren disease, especially in the setting of unexpected anatomic variants. It is paramount that surgeons remain vigilant in the unpredictable setting of these pathologic structures and strict adherence to their careful dissection and resection should be stressed