The septa of Legueu and Juvara: an anatomic study

Bilderback, Karl; Rayan, Ghazi M.

doi:10.1016/j.jhsa.2004.01.017

Cited by 19 publications

(5 citation statements)

References 7 publications

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“…A septum is located on either side of each flexor digitorum profundus and superficialis tendons of the index through the small fingers. These septa formed seven compartments or septal canals, four containing the flexor tendons and three containing the common digital nerves and arteries and the lumbrical muscles (Bilderback & Rayan, ).…”

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confidence: 99%

Plantar fascia anatomy and its relationship with Achilles tendon and paratenon

et al. 2013

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Although the plantar fascia (PF) has been studied quite well from a biomechanical viewpoint, its microscopic properties have been overlooked: nothing is known about its content of elastic fibers, the features of the extracellular matrix or the extent of innervation. From a functional and clinical standpoint, the PF is often correlated with the triceps surae muscle, but the anatomical grounds for this link are not clear. The aim of this work was to focus on the PF macroscopic and microscopic properties and study how Achilles tendon diseases might affect it. Twelve feet from unembalmed human cadavers were dissected to isolate the PF. Specimens from each PF were tested with various histological and immunohistochemical stains. In a second stage, 52 magnetic resonance images (MRI) obtained from patients complaining of aspecific ankle or foot pain were analyzed, dividing the cases into two groups based on the presence or absence of signs of degeneration and/or inflammation of the Achilles tendon. The thickness of PF and paratenon was assessed in the two groups and statistical analyses were conducted. The PF is a tissue firmly joined to plantar muscles and skin. Analyzing its possible connections to the sural structures showed that this fascia is more closely connected to the paratenon of Achilles tendon than to the Achilles tendon, through the periosteum of the heel. The PF extended medially and laterally, continuing into the deep fasciae enveloping the abductor hallucis and abductor digiti minimi muscles, respectively. The PF was rich in hyaluronan, probably produced by fibroblastic-like cells described as 'fasciacytes'. Nerve endings and Pacini and Ruffini corpuscles were present, particularly in the medial and lateral portions, and on the surface of the muscles, suggesting a role for the PF in the proprioception of foot. In the radiological study, 27 of the 52 MRI showed signs of Achilles tendon inflammation and/or degeneration, and the PF was 3.43 AE 0.48 mm thick (99%CI and SD = 0.95), as opposed to 2.09 AE 0.24 mm (99%CI, SD = 0.47) in the patients in which the MRI revealed no Achilles tendon diseases; this difference in thickness of 1.29 AE 0.57 mm (99%CI) was statistically significant (P < 0.001). In the group of 27/52 patients with tendinopathies, the PF was more than 4.5 mm thick in 5, i.e. they exceeded the threshold for a diagnosis of plantar fasciitis. None of the other 25/52 paitents had a PF more than 4 mm thick. There was a statistically significant correlation between the thicknesses of the PF and the paratenon. These findings suggest that the plantar fascia has a role not only in supporting the longitudinal arch of the foot, but also in its proprioception and peripheral motor coordination. Its relationship with the paratenon of the Achilles tendon is consistent with the idea of triceps surae structures being involved in the PF pathology, so their rehabilitation can be considered appropriate. Finally, the high concentration of hyaluronan in the PF points to the feasibility of using hyaluronan ...

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Plantar fascia anatomy and its relationship with Achilles tendon and paratenon

et al. 2013

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“…7 ). 21 22 Two ligaments run perpendicular to these pretendinous bands in a transverse plane. Skoog's ligament runs superficially off the flexor tendon at the level of the distal palmar crease, connecting the pretendinous bands ( Fig.…”

Section: Normal Anatomy and Imaging Correlationmentioning

confidence: 99%

Tardigrade and Manifold Sign: Two New Signs in Dupuytren's Disease

Reyntiens

Vanhoenacker

Jager

2023

Semin Musculoskelet Radiol

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Dupuytren's disease (DD) is a chronic benign fibroproliferative disorder of the palmar and digital fasciae. It is characterized by formation of nodules and fibrous cords that may eventually lead to contractures with permanent flexion of the finger joints. Correction of the flexion contractures in advanced disease is still performed by open limited fasciectomy; ultrasonography (US)-guided minimally invasive treatment is preferred for early disease.We provide an overview of the detailed anatomy of the palmar aponeurosis and the structures that may be involved in DD. Although magnetic resonance imaging is used as the gold standard, these small anatomical structures are often better visible on US. We describe two new morphological signs due to thickening of these small structures in patients with DD: the tardigrade sign and the manifold sign. Familiarity with detailed imaging anatomy and these new imaging signs of DD will help confirm a correct and early diagnosis and distinguish this disease from various other entities.

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“…The extracellular matrix, including collagen, attaches and coalesces to normal structures, such as palmar fascia, the bands of Legueu and Juvara, the lateral digital fascia, Grayson’s ligament, the annular pulleys, and other normal structures, which they ultimately deform through the contractile process 18 (Fig. 5 ).…”

Section: Coalescence and Contracturementioning

confidence: 99%

The Rationale for Treating the Nodule in Dupuytren’s Disease

Ketchum

2014

Plastic and Reconstructive Surgery Global Open

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Background:Dupuytren’s disease encompasses a spectrum of fibroblastic disorders from the presence of 1–2 nodules in the palm of a hand with no joint contracture to grotesque, crippling and disabling deformities of hands. Over the last 50 years, many enlightening studies have been forthcoming, which, through techniques of histopathology, biochemistry, tissue culture, and electron microscopy, have shed pearls of light on various aspects of the disease process.Methods:A comprehensive review of the literature on Dupuytren’s disease was undertaken, stringing together results from numerous studies to establish a table of events and their location in the development of the disease.Results:What will be seen is a credible scenario of events which will enable the clinician to be more proactive in the earlier treatment of the disease and more aware of factors that increase or decrease recurrence rates postoperatively.Conclusions:The most effective management of Dupuytren’s disease is early recognition and treatment of the nodule, before the development of a joint contracture, particularly of a proximal interphalangeal joint. As there is evidence of a significant inflammatory role in the development of the nodule, the process of fibroplasia can be minimized by altering the macrophage > fibroblast > collagen cascade by the intralesional injection of a potent anti-inflammatory agent such as triamcinolone, which also blocks tissue inhibitors of collagenase, thus enhancing the action of native collagenase, and reduces the size and firmness of nodules and, at least temporarily, arrests their progression.

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The septa of Legueu and Juvara: an anatomic study

Cited by 19 publications

References 7 publications

Plantar fascia anatomy and its relationship with Achilles tendon and paratenon

Plantar fascia anatomy and its relationship with Achilles tendon and paratenon

Tardigrade and Manifold Sign: Two New Signs in Dupuytren's Disease

The Rationale for Treating the Nodule in Dupuytren’s Disease

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