for ug n surgery pg

1. HAND SPACES ANATOMY &
INFECTIONS
G.NARENDRA TEJA
Nri medical college
Under guidance of dr.v.tatha rao ms

2. • Hand is covered by thick skin on palmar
side- to withstand trauma
• Palmar skin adherent to palmar
aponeurosis
• Underneath aponeurosis long flexor
tendons pass into fingers through
palmar arch
• This forms spaces in hand which can be
potential areas of infections

3. • Hand spaces
• Finger
– pulpspace
– Proximal & distal volar space
• Palm
– Web space
– Mid palmar space
– Thenar space
• Fore arm
– Space of parona
– Dorsum
– Subcutaneous space
– Sub aponeurotic space

5. Nail fold infection
• Paronychial/eponychial infections
• Most common infection in hand
• Cause- trivial trauma
• Infection starts beneath eponychyium &
tracks around nail fold & nail
• Treatment – lift nail fold & inscision &
drainage

6. Pulp space infection ( felon)
• Situated between thick palmar skin &
terminal phalanx
• Divided by multiple septa from skin to
phalanx
• These loculi are occupied by fibro fatty
tissue
• Distal 4/5th of phalanx is supplied by
branches from digital arteries passing
through septae
• If pus collects in this space ,tension
increases,leading to occlusion of arteries
• Leads to ischemia of phalanx ---
osteomyelitis

8. • Clinical features
• Severe throbbing pain in pulpspace
,aggravated by dependent position
• o/e – tense ,tender ,indurated pulp
space
• Rx –incision over point of maximal
tenderness
• If osteomyelitis –excision of bone

9. Web space infecton
• Spaces filled with areolar tissue
between slips of palmar aponeurosis at
bases of fingers in between them
Clinical features-
• Swollen base of finger with seperation
of fingers
• Rx transverse inscision over web space
• Counter incision on dorsal side if spread
to posteriorly

10. MID PALMAR SPACE INFECTION
• Lies under inner half of hollow of hand between
thenar & hypothenar eminences
• Shape- triangular
Boundaries
• Anteriorly- 3,4 flexor tendon sheaths ,3,4
lumbricals
• Posteriorly- metacarpal bones with interossei
• Radial side-fibrous tissue over thenar space
• Ulnar side- fibrous tissue over hypotenar space

11. • Proximal- transverse carpal ligament
• sometimes may extend into
fore arm space along flexor tendons
• Treatment- drainage of pus by incisions
in ¾ 0r 4/5 digits & opening lumbrical
sheath

13. • Clinical features
• Pain & tenderness in palm
• Edema on dorsum of hand
• Loss of concavity of palm
• Painful metacarophalangeal joint movement
• Fever
• Palpable axillary lymph nodes
• Collar stud abscess

14. complications
• Osteomyelitis
• Osteoartritis
• Stiffness of hand

15. Thenar space
• Lies under outer half of hollow of palm
• Triangular in shape
• Anteriorly- short muscles of
thumb,flexors of index finger,1,2
lumbricals
• Posteriorly- adductor pollicis
• Radially- radial bursa
• Ulnar -septum between thenar & midpalmar
• Distal –proximal transverse palmar crease
• Proximal –transverse carpal ligament

16. Fore arm space
• Space of parona
• Space in between flexor tendons &
pronator quadratus ,interosseous
membrane
• Boundaries
• Anterior- flexor digitorum profundus
with its synovial sheath
• - flexor pollicis longus in its
synovial sheath

17. • Posterior-pronator
quadratus,interosseous membrane
• Distal- reaches level of wrist
• Proximal- continuous withintermuscular
spaces of fore arm
• Cause- spread of infection from ulnar
/radial bursa

18. Clinical features ..
• Swelling in front of wrist or lower fore
arm
• Treatment
• Incisions & drainage at lateral/medial
borders of forearm

19. Dorsal spaces
• Areolar tissue is much looser than in
palm
• Divided into dorsal subcutaneous &
dorsal sub aponeurotic spaces
• Both are triangular shaped with apex at
wrist & base at knucles

20. • Dorsal surface recieves most of the
lymphatic drainage of hand,including
that from palmar surface
• Hence,even in palmar infections edema
occurs on dorsal surface

21. patholophysiology
• Local features of inflammation
stage of cellulitis
• - severe pain throbbing,aggravated in
dependent position
Stage of abscess/ brawny induration
• - do not manifest early because of thick
overlying fascia & skin
• Dx by triad of swelling ,induration,localised
tenderness

22. • All infections of hand are associated
with dorsal reactionary edema
• Lymphadenopathy
• General features – fever ,malaise,
tachycardia

23. THANK U