Spiralling of the neurovascular bundle in Dupuytren’s disease

Displacement of the neurovascular bundle within a digit affected by Dupuytren’s disease can occur when disease superficial to the neurovascular bundle is connected to disease deep to it. Contraction of such cords results in spiralling of the neurovascular bundle, classically when a pretendinous cord connects with the lateral digital sheet and Grayson’s ligament via the oblique cord, but also in association with an isolated digital cord. We describe six cases in which cord formation and contraction resulted in a distal spiral, which may occur in isolation or in combination with a classical proximal spiral, creating a double spiral or corkscrew neurovascular bundle.