Palmar spaces
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Transcript of Palmar spaces
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PALMAR SPACES
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The PALM
20 Intrinsic muscles9 Flexor tendonsUlnar & Median Nerves.Palmar arterial arches
Wrapped in Fascial layers
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FOUR COMPARTMENTS
THENAR
HYPOTHENAR
INTERMEDIATE
ADDUCTOR
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THENAR• Abductor Pollicis Brevis• Flexor Pollicis Brevis• Opponens Pollicis
HYPOTHENAR• Abductor Digiti Minimi• Flexor Digiti Minimi• Opponens Digiti Minimi
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INTERMEDIATE• Flexor tendons covered by Synovial sheaths• lumbricals• Palmar arterial arches• Branches of Median and Ulnar nerves
ADDUCTOR• Adductor Pollicis
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• 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
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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
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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
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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
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Hypothenar Space
• Posterior – 5th Metacarpal
• Lateral – Hypothenar septum
• Medial & Ant– Hypothenar Muscles
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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
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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
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Web Spaces• 4 Subcutaneous spaces
• From its free margin – extends to level of MCP joint.
• CONTENTS - S/C fatSuperficial transverse metacarpal ligament, interosseous and lumbrical tendons, digital nerves and vessels.
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• 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)
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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 along tenderness along
tendon sheathtendon sheath
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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
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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
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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.
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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
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Felon
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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
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Management of Infection
Incise, Incise, Culture, Culture, Irrigate, Irrigate, Antibiotics,Antibiotics,Soaks,Soaks,ROM,ROM,Resting SplintResting Splint
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THANK YOU