Palmar spaces

1. PALMAR SPACES

2. The PALM
20 Intrinsic muscles
9 Flexor tendons
Ulnar & Median Nerves.
Palmar arterial arches
Wrapped in Fascial layers

3. FOUR COMPARTMENTS
THENAR
HYPOTHENAR
INTERMEDIATE
ADDUCTOR

4. THENAR
•Abductor Pollicis Brevis
•Flexor Pollicis Brevis
•Opponens Pollicis
HYPOTHENAR
•Abductor Digiti Minimi
•Flexor Digiti Minimi
•Opponens Digiti Minimi

5. INTERMEDIATE
•Flexor tendons covered by Synovial sheaths
•lumbricals
•Palmar arterial arches
•Branches of Median and Ulnar nerves
ADDUCTOR
•Adductor Pollicis

6. •No well defined spaces inside the fascial
compartments
•Become apparent when there is collection
of pus
•Mid palmar septum/Intermediate palmar
septum divide intermediate comp into
Thenar & Mid palmar spaces

7. •

8. •

9. Palmar Spaces
MidPalmar space
Thenar space
Hypothenar space
Radial Bursa
Ulnar bursa
Interdigital Web spaces
Pulp spaces
Forearm space of Parona
Dorsal Sub aponeurotic space

10. Midpalmar space
•Anterior – Palmar aponeurosis,
superficial palmar arch,
flexor tendons of medial 3 digits covered in ulnar
bursa and medial 3 lumbricals
•Posterior - Fascia covering 3
rd
& 4
th
interossei and
metacarpal bones
•Medial – Medial Palmar septum
•Lateral - Midpalmar septum
•Proximal – distal margin of flexor retinaculum
•Distal - medial 2 web spaces thru lumbrical canals

11. Thenar Space
•Anterior - Palmar aponeurosis,
superficial palmar arch,
flexor tendon of index finger covered with
synovial sheath, tendon of FPL
•Posterior – fascia covering adductor pollicis
•Lateral - Lateral palmar septum
•Medial MidPalmar septum.
•Proximal – distal margin of flexor retinaculum
•Distal - 1
st
web space thru lumbrical canal

12. Hypothenar Space
•Posterior – 5
th
Metacarpal
•Lateral – Hypothenar septum
•Medial & Ant– Hypothenar Muscles

13. •

14. Radial Bursa
•Synovial sheath surrounding
Flexor Pollicis Longus tendon
•Extends from forearm( 2 cm prox to Flexor
retinaculum) to base of terminal phalanx of
thumb

15. Ulnar Bursa
•Common synovial sheath surrounding
tendons of Flexor digitorum superficialis
and profundus
•Extends from forearm( 2 cm prox to Flexor
retinaculum) to mid palm level where it
ends as cul-de-sac .
•Continuous with digital sheath around
flexor tendons of little finger

16. 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.

17. •Inflammation of synovial sheath
•Little finger – infects Ulnar bursa
•Thumb – infects Radial bursa
•Horse Shoe abscess
•Can extend to MidPalmar and Thenar
spaces (Pus tanks)
•Through lumbricals to Web spaces (Pus
taps)

18. Flexor Tenosynovitis
Kanavel’s Cardinal SignsKanavel’s Cardinal Signs
•finger in slight flexionfinger in slight flexion
•fusiform swellingfusiform swelling
•pain with extension.pain with extension.
•tenderness along tenderness along
tendon sheathtendon sheath

20. Thenar space inf
•Swelling of thenar area
•Thumb abducted & extended
•Index finger flexed.
Midpalmar space inf
•Dorsal swelling- inflated rubber glove
•Inability to move long & ring fingers- pain

22. Web space inf
•Collar button abscess due to hour glass
configuration
•Begins beneath palmar callus – in labourers
•Incisions – 1 dorsal and 1 palmar.
•Web - not incised

24. 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.

25. Contents
•Subcutaneous fatty tissue
•Loculated by tough fibrous septa -
Extending from skin to phalanx.
•Sensory nerves
•Digital artery
•ABSCESS – Whitlow/Felon
•Complication - AVN of distal 4/5
th
of
phalanx (thrombosis of diaphyseal br of
digital artery

26. Felon

27. FOREARM 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
•Lateral – FPL
•Medial - FCU
•Infections - Incision either side of lower 3
rd

of forearm

32. Management of Infection
Incise, Incise,
Culture, Culture,
Irrigate, Irrigate,
Antibiotics,Antibiotics,
Soaks,Soaks,
ROM,ROM,
Resting SplintResting Splint

33. THANK YOU