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Midpalmar, Thenar and Pulp Spaces
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Spaces of hand
- Boundaries, contents and applied aspect of midpalmar space.
- Boundaries, contents and applied aspect of thenar space.
- Boundaries, contents and applied aspect of pulp space. [/expand]
Spaces of the hand: The disposition of fascia and fascial septa in the hand results in the formation of potential spaces. These spaces are surgically important as they may get infected and distended with pus.
Following are the important spaces on the palmar aspect :
- Midpalmar space
- Thenar space
- Pulp spaces of the fingers
Midpalmar space:
- Shape: It is triangular in shape.
- Location: It lies in the medial half of the hollow of the palm.
- Extent: It extends
- proximally till the distal margin of flexor retinaculum,
- distally till the distal palmar crease.
- Boundaries:
- Anteriorly it is bounded by palmar aponeurosis and flexor tendons of middle three digits ( enclosed in ulnar bursa).
- Posteriorly it is bounded by the interossei and middle three metacarpals.
- Laterally it is bounded bythe intermediate palmar septum (extending from the palmar aponeurosis to the 3rd metacarpal).
- Medially it is bounded by the medial palmar septum ( extending from the palmar aponeurosis to the 5th metacatpal).
- Communications : It communicates
- proximally it communicates with the forearm space of Parona through carpal tunnel.
- distally with the medial three web spaces ( subcutaneous spaces in the interdigital cleft) through the medial three lumbrical canals (fascial sheaths of lumbricals).
Dranaige in case of infection: Pus from this space can be drained by incision in the 3rd and 4th web spaces.
Thenar space
- Shape: It is triangular in shape.
- Location: It lies in the outer half of the hollow of the palm.
- Extent : It extends
- proximally till the distal margin of flexor retinaculum.
- Distally till the proximal transversel palmar crease
- Boundaries:
- Anteriorly it is bounded by palmar aponeurosis and flexor tendon of index finger and tendon of flexor pollicis longus ( enclosed in radial bursa)and 1st lumbrical.
- Posteriorly it is bounded by the fascia covering adducor pollicis.
- Laterally it is bounded by the lateral palmar septum (extending from the palmar aponeurosis to the 1st metacarpal).
- Medially it is bounded by the intermediate palmar septum ( extending from the palmar aponeurosis to the 3rd metacatpal).
- Communication:
- It communicates distally with the 1st web space (subcutaneous space in the interdigital cleft) through the 1st lumbrical canal.
Drainage in case of infection: Pus from this space can be drained by incision in the 1st web space.
Pulp spaces of the fingers
- Are the subcutaneous spaces on the palmar aspect of the tips of the fingers and the thumb.
- They are filled with subcutaneous fatty tissue that is divided into compartments by the numerous fibrous septa which extend from the skin to the distal phalanx.
- Boundaries:
- Anteriorly they are bounded by theskin and superficial fascia
- Posteriorly they are bounded by the distal 2/3rd of the distal phalanx.
- Terminal branches of the digital artery course through the spaces to supply the diaphysis of the distal phalanx.
Applied Aspect
- Infection of the pulp spaces is known as ‘ Whitlow‘.
- If neglected, the whitlow may lead to the necrosis of distal 4/5th of the distal phalanx. This is due to the fact that the diaphysis of the distal phalanx (distal 4/5th) is supplied by the branches of the digital artery that traverse through the pulp space. The rising tension due to accumulation of pus may occlude these branches of the digital artery resulting in avascular necrosis of the distal 4/5th of the terminal phalanx. As the proximal 1/5th (epiphysis) of the distal phalanx receives blood supply proximal to the pulp space, it is not affected.
- Pus from the pulp space is drained by lateral incision which opens all the compartments.
I have understood the potential spaces of the hand, thanks to these explanations.
Benna