hand spaces anatomy & infections
TRANSCRIPT
HAND SPACES ANATOMY & INFECTIONS
G.NARENDRA TEJANri medical college
Under guidance of dr.v.tatha rao ms
• 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
• 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
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
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
• 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
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
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
• 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
• 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
complications
• Osteomyelitis• Osteoartritis• Stiffness of hand
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
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
• 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
Clinical features ..• Swelling in front of wrist or lower fore
arm• Treatment • Incisions & drainage at lateral/medial
borders of forearm
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
• 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
patholophysiology
• Local features of inflammation stage of cellulitis• - severe pain throbbing,aggravated in
dependent positionStage of abscess/ brawny induration• - do not manifest early because of thick
overlying fascia & skin• Dx by triad of
swelling ,induration,localised tenderness
• All infections of hand are associated with dorsal reactionary edema
• Lymphadenopathy• General features – fever ,malaise,
tachycardia
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