This document discusses the spaces of the forearm and hand. It begins with an introduction explaining that fascial septa form potential spaces filled with loose connective tissue. These spaces are clinically significant as they can become infected and limit the spread of infection. It then lists and describes the various forearm and hand spaces in detail, including the forearm space of Parona, palmar spaces (thenar, midpalmar, web), dorsal spaces, and superficial pulp spaces of the fingers. It concludes with discussions of clinical correlations of infections in these spaces, such as paronychia, felon, and appropriate incision sites for abscess drainage.

1. Why should we learn this topic?

2. Spaces of Forearm & Hand
Dr Mathew Joseph MBBS, MD(AIIMS), BCC(Palliative Medicine)
Assistant Professor
Department of Anatomy
Al Azhar Medical College & Super Speciality Hospital
Thodupuzha

3. Content
Spaces of Forearm & Hand:
1. Introduction
2. Boundaries
3. Contents
4. Clinical Correlations
5. Self Assesment
6. References

4. Why should we learn this topic?

6. Introduction
• Arrangement of the Fascia & Fascial Septa -
forms Spaces.
• Fascial spaces - Potential Spaces filled with
loose connective tissue.
• aka Surgical Spaces - Become infected and
distended with pus.
• Boundaries – clinical significance - May limit
the Spread of Infection in the palm.

7. List of Spaces
• FOREARM SPACE OF PARONA
• PALMAR SPACES
1. Thenar space
2. Midpalmar space
3. Web space
• DORSAL SPACES OF HAND
1. Dorsal subcutaneous space
2. Dorsal subaponeurotic space
• SUPERFICIAL PULP SPACE OF FINGERS

11. Forearm Space of Parona
• 1 Pronator quadratus
• 2 Space of Parona
• 3 Flexor carpi ulnaris
• 4 Flexor digitorum profundus
• 5 Median nerve
• 6 Flexor pollicis longus

12. Radial & Ulnar Bursae

13. Palmar Spaces
1. Thenar Space
2. Mid Palmar Space
3. Web Spaces
**Distally :
The Thenar & The Midpalmar spaces
are continuous with the appropriate
Lumbrical Canals.

14. Thenar Space
**Contains the 1st Lumbrical and lies posterior to the long Flexor tendons to
the Index finger and in front of the Adductor pollicis.

15. Mid Palmar Space
• Anterior:
• Long flexor tendons to the 3rd
4th 5th fingers.
• Posterior:
• Interossei
• 3rd 4th 5th metacarpal bones
• Adductor pollicis – Transverse
head

16. Web Spaces
• Potential spaces surrounding the tendon
of each Lumbrical muscle.
• Normally filled with connective tissue.
• Three in number – B/w Index, Mddle, Ring
and Little finger
• Proximally continuous with one of the
palmar spaces.

17. Pulp Spaces
• Filled with fat.
• Subdivided by numerous septa.
• Terminal branch of the digital artery -
Diaphysis of the distal phalanx.
• Epiphysis of the distal phalanx receives
its blood supply proximal to the pulp
space.

18. Dorsal Spaces
• Dorsal Subcutaneous space
• Dorsal Subaponeurotic space

19. Clinical Correlates

20. Paronychia
• Infection along lateral nail fold.
• Follows Trauma of nail bed.

22. Felon
• Subcutaneous abscess in pulp space of
finger.
• Pressure on the blood vessels could result
in Necrosis of the diaphysis.
• Epiphysis of this bone is saved because it
receives its arterial supply just proximal to
the pulp space.

24. Mid Palmar Space Infection

25. Thenar Space Infection

26. Web Space Infection

27. Incisions for Abscess Drainage

28. Self Assesment

29. 1. Which of the following is NOT a palmar fascial space
A. Thenar space
B. Midpalmar space
C. Space of Parona
D. Web space

30. 2. The digital synovial sheath of which finger communicates with the ulnar
bursa
A. Index finger
B. Middle finger
C. Ring finger
D. Little finger

31. 3. Which of the following is a content of the Thenar space?
A. Tendon of flexor carpi radialis
B. Tendon of flexor carpi ulnaris
C. Tendon of flexor pollicis longus
D. Tendon of flexor digitorum superficialis for Index finger

32. 4. The posterior boundary of the midpalmar space is formed by all EXCEPT
A. Palmar interossei
B. Dorsal interossei
C. Lumbricals
D. Fascia covering medial part of transverse head of adductor pollicis

33. 5. All of the following statements about the pulp space are true EXCEPT
A. Present at the finger tips
B. Fat present in loculated compartments
C. Infection may cause necrosis of diaphysis in children
D. Pulp space infections are usually painless

34. THANK YOU