Palmar spaces - Types / contents
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The document discusses the anatomy and clinical significance of various palmar spaces in the hand, including the superficial pulp spaces, synovial tendon sheaths, ulnar and radial bursae, thenar space, and midpalmar space. It highlights the potential for infections in these areas, their symptoms, and how they can spread, particularly focusing on conditions such as tenosynovitis and abscesses. The document serves as a resource for understanding the underlying structure and implications of infections related to these anatomical spaces.
Palmar spaces - Types / contents
- 1. PALMAR SPACES Dr.U. Murali. M.S;M.B.A. Prof. of Surgery D Y Patil Medical College Mauritius
- 2. Objectives Types of Spaces Location & Boundaries Contents Applied Anatomy
- 3. PALMAR SPACES Important spaces are - The superficial pulp spaces of the finger. The synovial tendon sheaths of the 2nd, 3rd and 4th finger. The ulnar bursa The radial bursa The midpalmar space The thenar space
- 4. Other Spaces Web spaces Space of Parona
- 6. Superficial Pulp Space Subcutaneous space between distal phalanx and skin of terminal digit. Proximally – closed anteriorly by fusion of fibrous flexor sheath to skin of digit at distal crease Posteriorly fusion of deep fascia to periosteum of terminal phalanx
- 7. Contents Subcutaneous fatty tissue Loculated by tough fibrous septa - extending from skin to phalanx. Sensory nerves Digital Artery
- 8. Applied Anatomy Infection of such a space is common and serious Commonly occurring in the thumb and index finger Bacteria are usually introduced into the space by pinpricks or sewing needles
- 9. Felon
- 10. Whitlow Whitlow is an infection of the pulp space of the finger, usually caused by herpes simplex type I virus (usually refer to herpetic whitlow )
- 12. Synovial tendon sheath The common synovial sheath for the flexor tendons is a synovial sheath in the carpal tunnel. It contains tendons of the flexor digitorum superficialis and the flexor digitorum profundus, but not the flexor pollicis longus.
- 13. The sheath which surrounds the Flexor digitorum extends downward about half-way along the metacarpal bones, where it ends in blind diverticula around the tendons to the index, middle, and ring fingers. It is prolonged on the tendons to the little finger and usually communicates with the mucous sheath of these tendons.
- 15. Tenosynovitis It is the inflammation of the fluid-filled sheath (called the synovium) that surrounds a tendon. Symptoms of tenosynovitis include pain, swelling and difficulty moving the particular joint where the inflammation occurs.
- 16. Flexor Tenosynovitis • FFiinnggeerr iinn sslliigghhtt fflleexxiioonn • FFuussiiffoorrmm sswweelllliinngg • PPaaiinn wwiitthh eexxtteennssiioonn.. • TTeennddeerrnneessss aalloonngg tteennddoonn sshheeaatthh
- 17. Trigger Finger When the condition causes the finger to "stick" in a flexed position, this is called "stenosing" tenosynovitis, commonly known as "Trigger Finger”
- 18. UUllnnaarr && RRaaddiiaall BBuurrssaa
- 19. The common and pollical sheaths are frequently referred to in clinical writing as the ulnar and radial bursae, respectively. These two sheaths project proximally a short distance above the flexor retinaculum, and they usually communicate with each other in the carpal tunnel. Hence infection of the synovial sheaths of the thumb or little finger may spread readily into the palm and even into the forearm.
- 21. Radial Bursa The synovial sheath of the tendon of flexor pollicis longus (radial bursa). This sheath is usually separate but may be communicate with the common sheath behind the retinaculum.
- 22. Radial Bursa Superiorly, it is coextensive with the common sheath and inferiorly it extends up to the distal phalanx of the thumb. Radial bursa – communicate with ulnar bursa at the level of wrist in about 50% of subj.
- 23. IInnffeeccttiioonn OOff RRaaddiiaall BBuurrssaa A patient's radial bursa is a continuation of the tendon sheath of his flexor pollicis longus, so that any infection inevitably involves both of them. The distal phalanx of the thumb is flexed and rigid. Pt cannot extend it, although can extend other fingers normally. The hand is tender over the sheath of flexor pollicis longus, and you may be able to feel a swelling above the flexor retinaculum. If treatment is delayed, infection may spread to the ulnar bursa, or the tendon of flexor pollicis longus may slough.
- 25. Ulnar Bursa Common flexor synovial sheath (ulnar bursa). The long flexor tendons of the fingers (flexor digitorum superficialis and profundus), are enclosed in a common synovial sheath while passing deep to the flexor retinaculum.
- 26. Ulnar Bursa The sheath has a parietal layer lining the walls of the carpal tunnel, and a visceral layer closely applied to the tendons. From the arrangement of the sheath it appears that the synovial sac has been invaginated by the tendons from its lateral side.
- 27. Ulnar Bursa Medial part, common sheath extends distally on the tendons of little finger. Lateral part, it stops on the middle of palm. Distal ends of index, middle & ring finger acquire digital synovial sheaths..
- 28. IInnffeeccttiioonn OOff UUllnnaarr BBuurrssaa Infection of the ulnar bursa is the most serious hand infection, because it contains all the flexor tendons of a patient's fingers. Pt’s whole hand is oedematous, the palm is moderately swollen, and there may be fullness immediately above the flexor retinaculum. The flexed fingers resist extension, particularly the little one, and least of all is the index. The radial and ulnar bursa sometimes communicate with one another. So if one of them has been infected, infection may follow in the other a day or two later.
- 30. Thenar Space - Location The Thenar space lies posterior to the long flexor tendons to the index finger and in front of the adductor pollicis muscle.
- 31. Boundaries Anterior - Palmar aponeurosis / superficial palmar arch, flexor tendon of index finger covered with synovial sheath / tendon of FPL Posterior – fascia covering adductor pollicis
- 32. Boundaries Lateral - Lateral palmar septum Medial - MidPalmar septum Proximal – distal margin of flexor retinaculum Distal - 1st web space thru lumbrical canal
- 33. Thenar Space (Lateral Central Palmar Space ) • Contains: Tendons of FPL / FDS&P to index finger, palmar digital nerves and vessels to thumb and radial side of index finger. • Communicates: web of thumb and under flexor retinaculum
- 34. Thenar space infection Closed space infection of the thenar space. • Pain and swelling of thenar eminence and first web space. • Can be from tenosynovitis of 2nd digit with rupture proximally. • Thumb is held abducted and flexed.
- 36. Clinical Significance The thenar space lies just superficial to the adductor pollicis muscle, forming a plane connecting the deep aspects of the radial bursa and the ulnar bursa. Abscess or space occupying lesions may spread transversely through the thenar space deep in the palm between the thumb and the carpal tunnel.
- 37. MMiidd –– PPaallmmaarr ssppaaccee
- 38. Location The Midpalmar space lies posterior to the long flexor tendons to the middle, ring and little fingers. It lies in front of the interossei and the 3rd, 4th and 5th metacarpal bone.
- 39. Boundaries Anterior – Palmar aponeurosis / superficial palmar arch, flexor tendons of medial 3 digits covered in ulnar bursa and medial 3 lumbricals Posterior - Fascia covering 3rd & 4th interossei and metacarpal bones
- 40. Boundaries Medial – Medial Palmar septum Lateral - Midpalmar septum Proximal – distal margin of flexor retinaculum Distal - medial 2 web spaces thru lumbrical canals
- 41. Mid Palmar Space (Mid Central Palmar Space) Contains: 3-5 flexor tendons, 2-4 lumbricals, superficial palmar arch, 3-5 digital vessels and nerves. Communicates: subcutaneous tissues at webs and extends dorsal to common flexor sheaths.
- 42. Mid Palmar infection Closed space infection of the palmar space. • Loss of normal hand concavity. • Tenderness of central palm. • Pain with movement of 3rd and 4th digits. • Can be from tenosynovitis of digits 3,4,5
- 45. Web Spaces 4 Subcutaneous spaces From its free margin – extends to level of MCP joint. Contents - S/C fat Superficial transverse metacarpal ligament, interosseous and lumbrical tendons, digital nerves and vessels.
- 46. Interdigital Infection Collar button abscess due to hour glass configuration Begins beneath palmar callus – in labourers Incisions – 1 dorsal and 1 palmar. Web - not incised
- 47. Space of Parona Located in forearm Continuous with palmar space through flexor tendons through carpal tunnel Anterior boundary - flexor tendons covered with tendon sheath Posterior boundary - Pronator quadratus