Fascial Spaces In The Hand 3p223r

Fascial spaces in the hand

In the olden days, the palm is said to be containing a mid palmar space and a thenar space where pus can be accumulated.

This view is discarded now.

 Mid

palmar space  Thenar space  Pulp spaces of fingers  Web spaces  Sub cutaneous space and  Sub aponeurotic space on the dorsum

Palmar aponeurosis

Palmar aponeurosis and septa

M

1

L

3

TS of left hand

5

Thenar space

•The subcutaneous fat that constitutes the tips of the fingers is loculated by fibrous septa and occupies a closed pulp space which is liable to infection (whitlow) from a penetrating wound.

This may be followed by the damage to the distal phalanx owing to the interruption of its blood supply.

whitlow

Fibrous flexor sheaths 

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

Thick fibrous arches with cruciform ligaments convert the concavity of metacarpals and phalanges into tunnels and protect the flexor tendons from slipping. Inside these tunnels the tendons are enclosed in synovial sheaths called “digital synovial sheaths”

Digital synovial sheaths 

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

As the digital flexor tendons through the carpal tunnel they are all enclosed in a single (common) synovial sheath.(ulnar bursa) The FPL has its own synovial sheath.(radial bursa)

Note the continuity between th little finger’s digital sheath with the common sheath

“Dupuytren's contracture” of one or more fingers, especially the little and ring fingers, is commonly attributed to thickening and shortening of the palmar aponeurosis. Its causation is not really understood.

Space of parona  The

common synovial sheath extends in to the lower forearm into a space called “space of parona”(limited proximally by the radial attachment of FDS)

infection of the synovial sheaths of the thumb or little finger may spread readily into the palm and even into the forearm(space of parona) Untreated infection of the synovial sheaths can impair hand function

Spaces on the dorsum  Subcutaneous

space lies just under the

skin.  Sub aponeurotic space lies deep to the extensor tendons.  Infections from fingers and palm can spread to these through lymphatics.

The Z-position of the hand, produced by the interossei and lumbricals (Flexion at M-P ts and extension at I-P ts)

Claw hand, due to paralysis of the interossei and lumbricals (following lesions of the ulnar nerve). The unopposed extensor and flexors produce the opposite of the Z-position. (extension at M-P t and flexion atI-P ts)

Other clinical aspects  Abd.pol.longus

and ext.pol.brevis run in the same synovial sheath which rubs against radial styloid process and this could lead to tenosynovitis and may impair movements.

Hand at rest (for immobilization)