The document discusses the fascial spaces of the palm and dorsum of the hand. It describes the midpalmar space, thenar space, and pulp space on the palm, and the dorsal subcutaneous space and dorsal subaponeurotic space on the dorsum. It outlines the boundaries and contents of each space and their clinical significance. The spaces are important for surgeons to understand to avoid injury during procedures.

1. Lecture by
Dr. N.Mugunthan.MBBS,MS,DNB,MNAMS,PhD,MBA(Hosp.Adm.)
Professor of Anatomy @ SMIMS

2.  Fascial spaces of palm & dorsum of hand
 Midpalmar Space
 Thenar Space
 Pulp Space
 Boundaries
 Surgical significance
 Space of Parona
 Ulnar & radial bursa
© Dr.N.Mugunthan

3.  PALM
 Midpalmar Space
 Thenar Space
 Adductor Space
 Lumbrical Canal
 Pulp Space
 DORSUM
 Dorsal Subcutaneous Space
 Dorsal Subaponeurotic
Space
© Dr.N.Mugunthan

4.  Anteriorly
▪ Flexor tendons of middle, ring and
little finger with synovial sheath,
▪ Second, third and fourth
lumbricals
▪ Palmar aponeurosis
 Posteriorly
▪ Third to fifth metacarpal with
interossei muscles
 Medially
▪ Medial palmar septum
 Laterally
▪ Intermediate palmar septum
© Dr.N.Mugunthan

5.  Distally
▪ Lumbrical canals
 Proximally
▪ Closed by synovial sheath
with carpal tunnel
▪ Space of Parona
© Dr.N.Mugunthan

6. © Dr.N.Mugunthan

7.  Triangular
 Boundaries
 Front
▪ Palmar aponeurosis,tendon
of flexor pollicis longus &
flexor tendon of index finger
 Behind
▪ Fascia covering transverse
head of adductor pollicis
 Lateral
▪ Lateral palmar septum
 Medial
▪ Intermediate palmar septum© Dr.N.Mugunthan

8.  Distally
▪ Lumbrical canal
 Proximally
▪ Closed under flexor
retinaculum
© Dr.N.Mugunthan

9. © Dr.N.Mugunthan

10. © Dr.N.Mugunthan

11. © Dr.N.Mugunthan

12.  Anteriorly
• Adductor pollicis
 Posteriorly
• 1st & 2nd dorsal
interossei,
• First palmar
interossei and
• 2nd metacarpal.
© Dr.N.Mugunthan

13.  Anteriorly first dorsal
interossei.
 Posteriorly skin and
deep fascia.
 Diverticula extend to
index finger and
thumb.
 Radial artery pass
through it.
© Dr.N.Mugunthan

14.  Closed space
 Anteriorly skin of the
pulp of finger
 Posteriorly periosteum
of the distal phalynx
 Divided by septa into
tight compartments &
filled with fibrofatty
tissue
© Dr.N.Mugunthan

15.  Proximal one fifth of distal
phalanx gets blood supply by
digital arteries, which does
not pass through septa
 Distal part gets blood supply
by digital arteries which pass
through septa
 So distal 4/5th of distal
phalynx is prone for avascular
necrosois
 And proximal 1/5th usually
escape form necrosis© Dr.N.Mugunthan

16. © Dr.N.Mugunthan

17.  Between skin and superficial
fascia
 Content
 Dorsal venous arch
 Dorsal digital branch of radial
& ulnar nerve.
© Dr.N.Mugunthan

18.  Between deep fascia
and dorsal surface of
metacarpal bone and
interossei
 Content
 Extensor tendons
 Dorsal carpal arch
 Infected through
lymphatics from palmar
surface
© Dr.N.Mugunthan

19.  Front
 Tendons of flexor
digitorum profundus
and flexor pollicis
longus
 Behind
 Pronator quadratus
 Communicates with
midpalmar space
PQ
© Dr.N.Mugunthan

20.  Radial bursa – synovial
sheath of FPL
 Ulnar bursa – common
synovial sheath of long
flexor tendons of
medial 4 fingers (FDS &
FDP).
 Ulnar bursa continuous
with synovial sheath of
little finger
© Dr.N.Mugunthan

21.  Fascial spaces of palm & dorsum of hand
 Midpalmar Space
 Thenar Space
 Pulp Space
 Boundaries
 Surgical significance
 Space of Parona
 Ulnar & radial bursa
© Dr.N.Mugunthan

22. © Dr.N.Mugunthan

23. https://drive.google.com/file/d/0Byc1vDJX
szA5aHlRUTk3NEkteE0/view?usp=sharing