1. PALMAR SPACES

2. The PALM
20 Intrinsic muscles
9 Flexor tendons
Ulnar & Median Nerves.
Palmar arterial arches
Wrapped in Fascial layers

3. FOUR COMPARTMENTS
THENAR
HYPOTHENAR
INTERMEDIATE
ADDUCTOR

4. THENAR
• Abductor Pollicis Brevis
• Flexor Pollicis Brevis
• Opponens Pollicis
HYPOTHENAR
• Abductor Digiti Minimi
• Flexor Digiti Minimi
• Opponens Digiti Minimi

5. INTERMEDIATE
• Flexor tendons covered by Synovial sheaths
• lumbricals
• Palmar arterial arches
• Branches of Median and Ulnar nerves
ADDUCTOR
• Adductor Pollicis

6. • No well defined spaces inside the fascial
compartments
• Become apparent when there is collection
of pus
• Mid palmar septum/Intermediate palmar
septum divide intermediate comp into
Thenar & Mid palmar spaces

7. •

8. •

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. Midpalmar space
• Anterior – Palmar aponeurosis,
superficial palmar arch,
flexor tendons of medial 3 digits covered in ulnar
bursa and medial 3 lumbricals
• Posterior - Fascia covering 3rd
& 4th
interossei and
metacarpal bones
• Medial – Medial Palmar septum
• Lateral - Midpalmar septum
• Proximal – distal margin of flexor retinaculum
• Distal - medial 2 web spaces thru lumbrical canals

11. Thenar Space
• Anterior - Palmar aponeurosis,
superficial palmar arch,
flexor tendon of index finger covered with
synovial sheath, tendon of FPL
• Posterior – fascia covering adductor pollicis
• Lateral - Lateral palmar septum
• Medial MidPalmar septum.
• Proximal – distal margin of flexor retinaculum
• Distal - 1st
web space thru lumbrical canal

12. Hypothenar Space
• Posterior – 5th
Metacarpal
• Lateral – Hypothenar septum
• Medial & Ant– Hypothenar Muscles

13. •

14. Radial Bursa
• Synovial sheath surrounding
Flexor Pollicis Longus tendon
• Extends from forearm( 2 cm prox to Flexor
retinaculum) to base of terminal phalanx of
thumb

15. Ulnar Bursa
• Common synovial sheath surrounding
tendons of Flexor digitorum superficialis
and profundus
• Extends from forearm( 2 cm prox to Flexor
retinaculum) to mid palm level where it
ends as cul-de-sac .
• Continuous with digital sheath around
flexor tendons of little finger

16. Web Spaces
• 4 Subcutaneous spaces
• From its free margin – extends to level of
MCP joint.
• CONTENTS - S/C fat
Superficial transverse metacarpal ligament,
interosseous and lumbrical tendons,
digital nerves and vessels.

17. • Inflammation of synovial sheath
• Little finger – infects Ulnar bursa
• Thumb – infects Radial bursa
• Horse Shoe abscess
• Can extend to MidPalmar and Thenar
spaces (Pus tanks)
• Through lumbricals to Web spaces (Pus
taps)

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 along
tendon sheathtendon sheath

20. 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

22. Web space inf
• Collar button abscess due to hour glass
configuration
• Begins beneath palmar callus – in labourers
• Incisions – 1 dorsal and 1 palmar.
• Web - not incised

24. Pulp Space
• Subcutaneous space between distal
phalanx and skin of terminal digit.
• Proximally – closed anteriorly by fusion of
fibrous flexor sheath to skin of digit at distal
crease
• Posteriorly fusion of deep fascia to
periosteum of terminal phalanx.

25. 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 4/5th
of
phalanx (thrombosis of diaphyseal br of
digital artery

26. Felon

27. FOREARM SPACE OF PARONA
• Located in forearm
• Continuous with palmar space through
flexor tendons through carpal tunnel
• Anterior boundary - flexor tendons
covered with tendon sheath
• Posterior boundary - Pronator quadratus
• Lateral – FPL
• Medial - FCU
• Infections - Incision either side of lower 3rd
of forearm

32. Management of Infection
Incise,Incise,
Culture,Culture,
Irrigate,Irrigate,
Antibiotics,Antibiotics,
Soaks,Soaks,
ROM,ROM,
Resting SplintResting Splint

33. THANK YOU