Palmar spaces

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Palmar spaces

  1. 1. PALMAR SPACES
  2. 2. The PALM20 Intrinsic muscles9 Flexor tendonsUlnar & Median Nerves.Palmar arterial archesWrapped in Fascial layers
  3. 3. FOUR COMPARTMENTSTHENARHYPOTHENARINTERMEDIATEADDUCTOR
  4. 4. THENAR• Abductor Pollicis Brevis• Flexor Pollicis Brevis• Opponens PollicisHYPOTHENAR• Abductor Digiti Minimi• Flexor Digiti Minimi• Opponens Digiti Minimi
  5. 5. INTERMEDIATE• Flexor tendons covered by Synovial sheaths• lumbricals• Palmar arterial arches• Branches of Median and Ulnar nervesADDUCTOR• Adductor Pollicis
  6. 6. • 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
  7. 7.
  8. 8.
  9. 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. 10. Midpalmar space• Anterior – Palmar aponeurosis,superficial palmar arch,flexor tendons of medial 3 digits covered in ulnarbursa and medial 3 lumbricals• Posterior - Fascia covering 3rd& 4thinterossei andmetacarpal bones• Medial – Medial Palmar septum• Lateral - Midpalmar septum• Proximal – distal margin of flexor retinaculum• Distal - medial 2 web spaces thru lumbrical canals
  11. 11. Thenar Space• Anterior - Palmar aponeurosis,superficial palmar arch,flexor tendon of index finger covered withsynovial sheath, tendon of FPL• Posterior – fascia covering adductor pollicis• Lateral - Lateral palmar septum• Medial MidPalmar septum.• Proximal – distal margin of flexor retinaculum• Distal - 1stweb space thru lumbrical canal
  12. 12. Hypothenar Space• Posterior – 5thMetacarpal• Lateral – Hypothenar septum• Medial & Ant– Hypothenar Muscles
  13. 13.
  14. 14. Radial Bursa• Synovial sheath surroundingFlexor Pollicis Longus tendon• Extends from forearm( 2 cm prox to Flexorretinaculum) to base of terminal phalanx ofthumb
  15. 15. 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
  16. 16. 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.
  17. 17. • 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)
  18. 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 alongtenderness alongtendon sheathtendon sheath
  19. 19. 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
  20. 20. 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
  21. 21. 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.
  22. 22. 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
  23. 23. Felon
  24. 24. 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
  25. 25. Management of InfectionIncise,Incise,Culture,Culture,Irrigate,Irrigate,Antibiotics,Antibiotics,Soaks,Soaks,ROM,ROM,Resting SplintResting Splint
  26. 26. THANK YOU

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