INTERMEDIATE• Flexor tendons covered by Synovial sheaths• lumbricals• Palmar arterial arches• Branches of Median and Ulnar nervesADDUCTOR• Adductor Pollicis
• No well defined spaces inside the fascialcompartments• Become apparent when there is collectionof pus• Mid palmar septum/Intermediate palmarseptum divide intermediate comp intoThenar & Mid palmar spaces
Radial Bursa• Synovial sheath surroundingFlexor Pollicis Longus tendon• Extends from forearm( 2 cm prox to Flexorretinaculum) to base of terminal phalanx ofthumb
Ulnar Bursa• Common synovial sheath surroundingtendons of Flexor digitorum superficialisand profundus• Extends from forearm( 2 cm prox to Flexorretinaculum) to mid palm level where itends as cul-de-sac .• Continuous with digital sheath aroundflexor tendons of little finger
Web Spaces• 4 Subcutaneous spaces• From its free margin – extends to level ofMCP joint.• CONTENTS - S/C fatSuperficial transverse metacarpal ligament,interosseous and lumbrical tendons,digital nerves and vessels.
• Inflammation of synovial sheath• Little finger – infects Ulnar bursa• Thumb – infects Radial bursa• Horse Shoe abscess• Can extend to MidPalmar and Thenarspaces (Pus tanks)• Through lumbricals to Web spaces (Pustaps)
Flexor TenosynovitisKanavel’s Cardinal SignsKanavel’s Cardinal Signs• finger in slight flexionfinger in slight flexion• fusiform swellingfusiform swelling• pain with extension.pain with extension.• tenderness alongtenderness alongtendon sheathtendon sheath
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
Web space inf• Collar button abscess due to hour glassconfiguration• Begins beneath palmar callus – in labourers• Incisions – 1 dorsal and 1 palmar.• Web - not incised
Pulp Space• Subcutaneous space between distalphalanx and skin of terminal digit.• Proximally – closed anteriorly by fusion offibrous flexor sheath to skin of digit at distalcrease• Posteriorly fusion of deep fascia toperiosteum of terminal phalanx.
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 4/5thofphalanx (thrombosis of diaphyseal br ofdigital artery
FOREARM SPACE OF PARONA• Located in forearm• Continuous with palmar space throughflexor tendons through carpal tunnel• Anterior boundary - flexor tendonscovered with tendon sheath• Posterior boundary - Pronator quadratus• Lateral – FPL• Medial - FCU• Infections - Incision either side of lower 3rdof forearm
Management of InfectionIncise,Incise,Culture,Culture,Irrigate,Irrigate,Antibiotics,Antibiotics,Soaks,Soaks,ROM,ROM,Resting SplintResting Splint