Spaces of Hand and Forearm

AnatomyofSpacesof Hand and Forearm

1. Why should we learn this topic?

2. Spaces of Forearm & Hand Dr Mathew Joseph MBBS, MD(AIIMS), BCC(Palliative Medicine) Assistant Professor Department of Anatomy Al Azhar Medical College & Super Speciality Hospital Thodupuzha

3. Content Spaces of Forearm & Hand: Introduction Boundaries Contents Clinical Correlations Self Assesment References

4. Why should we learn this topic?

5. Introduction Arrangement of the Fascia & Fascial Septa - forms Spaces. Fascial spaces - Potential Spaces filled with loose connective tissue. a ka Surgical Spaces - Become infected and distended with pus. B oundaries – clinical significance - May limit the Spread of Infection in the palm.

6. List of Spaces FOREARM SPACE OF PARONA PALMAR SPACES Thenar space Midpalmar space Web space DORSAL SPACES OF HAND Dorsal subcutaneous space Dorsal subaponeurotic space SUPERFICIAL PULP SPACE OF FINGERS

7. Forearm Space of Parona 1 Pronator quadratus 2 Space of Parona 3 Flexor carpi ulnaris 4 Flexor digitorum profundus 5 Median nerve 6 Flexor pollicis longus

8. Radial & Ulnar Bursae

9. Palmar Spaces Thenar Space Mid Palmar Space Web Spaces ** Distally : The Thenar & The Midpalmar spaces are continuous with the appropriate Lumbrical Canals.

10. Thenar Space **Contains the 1st Lumbrical and lies posterior to the long Flexor tendons to the Index finger and in front of the Adductor pollicis .

11. Mid Palmar Space Anterior : Long flexor tendons to the 3 rd 4th 5th fingers. Posterior : Interossei 3 rd 4th 5 th metacarpal bones Adductor pollicis – Transverse head

12. Web Spaces Potential spaces surrounding the tendon of each Lumbrical muscle . Normally filled with connective tissue . Three in number – B/w Index , M ddle , Ring and L ittle finger Proximally continuous with one of the palmar spaces.

13. Pulp Spaces Filled with fat . Subdivided by numerous septa. Terminal branch of the digital artery - Diaphysis of the distal phalanx . E piphysis of the distal phalanx receives its blood supply proximal to the pulp space.

14. Dorsal Spaces Dorsal Subcutaneous space Dorsal Subaponeurotic space

15. Clinical Correlates

16. Paronychia Infection along lateral nail fold. Follows Trauma of nail bed.

17. Felon Subcutaneous abscess in pulp space of finger. Pressure on the blood vessels could result in Necrosis of the diaphysis . Epiphysis of this bone is saved because it receives its arterial supply just proximal to the pulp space.

18. Mid Palmar Space Infection

19. Thenar Space Infection

20. Web Space Infection

21. Incisions for Abscess Drainage

22. Self Assesment

23. 1. Which of the following is NOT a palmar fascial space A. Thenar space B. Midpalmar space C. Space of Parona D. Web space

24. 2. The digital synovial sheath of which finger communicates with the ulnar bursa A. Index finger B. Middle finger C. Ring finger D. Little finger

25. 3. Which of the following is a content of the Thenar space? A . Tendon of flexor carpi radialis B. Tendon of flexor carpi ulnaris C. Tendon of flexor pollicis longus D. Tendon of flexor digitorum superficialis for Index finger

26. 4. The posterior boundary of the midpalmar space is formed by all EXCEPT A. Palmar interossei B. Dorsal interossei C. Lumbricals D. Fascia covering medial part of transverse head of adductor pollicis

27. 5. All of the following statements about the pulp space are true EXCEPT A. Present at the finger tips B. Fat present in loculated compartments C. Infection may cause necrosis of diaphysis in children D. Pulp space infections are usually painless

28. THANK YOU