Scientific article| Volume 44, ISSUE 4, P341.e1-341.e6, April 2019

Grayson Ligament: A Revised Description of its Anatomy and Function

Published:August 28, 2018DOI:


      Grayson ligament has been described as a common pathway for digital contracture in Dupuytren disease. Its anatomical descriptions in the literature are, however, inconsistent.


      We have performed a microsurgical dissection study in 20 fresh-frozen and thawed digits to revisit the anatomy of Grayson ligaments. We also performed dissections in Thiel-preserved hands to be able to study the changes in tension of the ligaments during flexion and extension of the finger.


      We found the ligaments originally described by Grayson to be the best developed part of a trabecular network of fibers, originating in continuity with the outer adventitial layer of the flexor tendon sheath and running toward their insertions into the skin in multiple planes, all volar to the neurovascular bundle. The most dorsal fibers, which cover the neurovascular bundles, form a chevron shape with its midline apex pointing distally in an extended finger. During flexion, the fibers become more transversely oriented.


      We found Grayson ligament comprises a trabecular network of fibers, instead of a ligament, with a dynamic fiber orientation on the volar side of the finger. The main function of this network of fibers seems to be the stabilization of the skin and fat pad in digit extension while the relaxation in flexion allows the skin and volar fat pad to adapt optimally to the form of the object that is held.

      Clinical relevance

      The new insights in the anatomy of Grayson trabecular network of fibers may be of importance in the understanding of the pathological anatomy of Dupuytren disease.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hand Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • McFarlane R.M.
        The anatomy of Dupuytren's disease.
        in: McFarlane R.M. McGrouther D.A. Flint M. Dupuytren's Disease: Biology and Treatment. Churchill Livingstone, Edinburgh1990: 55-72
        • McGrouther D.A.
        Dupuytren's contracture.
        in: Green D.P. Hotchkiss R.N. Pederson W.C. Green's Operative Hand Surgery. 5th ed. Elsevier Churchill Livingstone, Philadelphia2005: 159-185
        • Grayson J.
        The cutaneous ligaments of the digits.
        J Anat. 1941; 75: 164-165
        • McFarlane R.M.
        Patterns of the diseased fascia in the fingers in Dupuytren’s contracture. Displacement of the neurovascular bundle.
        Plast Reconstr Surg. 1974; 54: 31-44
        • Thiel W.
        The preservation of the whole corpse with natural color [in German].
        Ann Anat. 1992; 174: 185-195
        • Milford L.W.J.
        Retaining Ligaments of the Digits of the Hand: Gross and Microscopic Anatomical Study.
        WB Saunders, Philadelphia1968
        • Cleland J.
        Cutaneous ligament of the phalanges.
        J Anat Physiol. 1878; 12: 524.2-527
        • Mester S.
        • Schmidt B.
        • Szabo G.
        • Toth F.
        • Nyarady J.
        Biomechanics of the membranous flexor tendon sheath: the role of Grayson's ligaments.
        Plast Reconstr Surg. 2006; 117: 497-506
        • De-Ary-Pires B.
        • Valdez C.F.
        • Shecaira A.P.
        • de Ary-Pires R.
        • Ary Pires-Neto M.
        Cleland’s and Grayson’s ligaments of the hand: a morphometrical investigation.
        Clin Anat. 2007; 20: 68-76