A system of surgery : theoretical and practical . ally idle extensors, and becamegradually affected with secondary shortening. The normal hand, placed as near as may be into the shape of one of these very con-tracted hands, so nearly resembles it, except as regards the absence of distinct contrac-tion of tissues, that it is difficult not to beKeve that the skin has as much to do withthe prominent ridges and furrows as the fascia, and that they are both thrown intofolds by muscular action; in fact, that nerve muscle and tendon are the primary agentsin the contraction, and not the fascia, as Dup
A system of surgery : theoretical and practical . ally idle extensors, and becamegradually affected with secondary shortening. The normal hand, placed as near as may be into the shape of one of these very con-tracted hands, so nearly resembles it, except as regards the absence of distinct contrac-tion of tissues, that it is difficult not to beKeve that the skin has as much to do withthe prominent ridges and furrows as the fascia, and that they are both thrown intofolds by muscular action; in fact, that nerve muscle and tendon are the primary agentsin the contraction, and not the fascia, as Dupuytren and subsequent writers (ourselvesincluded) maintained. Often a prominent flexor tendon is pi-edominant in the palm ;we have seen the palmaris longus fmuscle and tendon in the foi-earm tensely con-tracted (see a case of this kind in Dupuytren ). When the patient is requested to ^ Sydenham Soc. Works, vol. 1854. In the case in question, Dupuytren, it wouldappear, impressed with the idea of the dependence of the complaint upon disease of the. 254 ORTHOPAEDIC SURGERY. act upon the muscles of the forearm, the above tendons are Ienderecl more tense andthe distortion is increased. Doubtless the office of the palmaris longus is to render thepalmar fascia tense. On full consideration of the arguments we could adduce for oragainst the nervo-muscular theory of the origin of this distortion, we arrive at theconclusion that this is the true cause and not disease of the fascia.^ Treatment.—Even in tolerably advanced cases, frictions, manipulations twice oroftenei- daily, the application of a screw-adjustment spKnt, or straight splints of wood,tin, or gutta-percha, will, if suitably and perseveringly used, reduce the contractionand deformity. But at the advanced age at which many patients present themselvesfor relief, the employment of mechanical apparatus encoiinters many difficulties. Inrigid unjdelding cases of long duration, subcutaneous section is remarkably effica-cious. We can
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