Human Anatomy Vol 1

A. Palmar spaces

1. Pulp space of the fingers


2. Midpalmar space


3. Thenar space
   B. Dorsal spaces


4. Dorsal subcutaneous space


5. Dorsal subaponeurotic space
   C. The foredrm space of Parona.

Pulp Spoce of lhe Fingers
The tips of the fingers and thumb contain subcutaneous
fat arranged in tight compartments formed by fibrous
septa which pass from the skin to the periosteum of
the terminal phalanx. Infection of this space is known
as whitlow. The rising tension in the space gives rise to
severe throbbing pain.
Infections in the pulp space (whitlow) can be drained
by a lateral incision which opens all compartments and
avoids damage to the tactile tissue in front of the finger.
If neglected, a whitlow may lead to necrosis of the
distal four-fifths of the terminal phalanx due to
occlusion of the vessels by the tension. The proximal
one-fifth (epiphysis) escapes because its artery does not
traverse the fibrous septa (Fig.9.51).

Midpolmor Spoce ond Thenor Spoce

Midpalmar and thenar spaces are shown tnTable 9.7
and Figs 9.52 and9.53.

Dorsol Spoces

The dorsal subcutaneous space lies immediately deep to
the loose skin of the dorsum of the hand. The dorsal

FOREARM AND HAND

subtendinous space lies between the metacarpal bones

and the extensor tendons which are united to one

another by a thin aponeurosis.

Foreorm Spoce of Porono

Forearm space of Parona is a rectangular space situated

deep in the lower part of the forearm just above the

wrist. It lies in front of the pronator quadratus, and deep

to the long flexor tendons. Superiorly, the space extends

up to the oblique origin of the flexor digitorum

superficialis. Inferiorly, it extends up to the flexor

retinaculum, and communicates with the midpalmar

space. The proximal part of the flexor synovial sheaths

protrudes into the forearm space.

Features

1. Shape


2. Situation


3. Extent:
   Proximal
   Distal


4. Communications:
   Proximal
   Distal


5. Boundaries:
   Anterior

Midpalmar space

Triangular

Under the inner half of the hollow of the palm

Distal margin of the flexor retinaculum

Distal palmar crease

Forearm space of parona

Fascial sheaths of the 3rd and 4th lumbricals

. Flexor tendons of 3rd, 4th and 5th fingers
. 2nd, 3rd and 4th lumbricals
. Palmar aponeurosis

Fascia covering interossei and metacarpals

lntermediate palmar septum

Medial palmar septum

Incision in either the 3rd or 4th web space

Thenar space

Triangular

Under the outer half of the hollow of the palm

Distal margin of the flexor retinaculum

Proximal transverse palmar crease

Forearm space

Fascial sheath of the first lumbrical

. Short muscles of thumb
. Flexor tendons of the index finger
. First lumbrical
. Palmar aponeurosis
Transverse head of adductor pollicis
. Tendon of flexor pollicis longus with radial bursa
. Lateral palmar septum
lntermediate palmar septum
lncision in the first web, posteriorly

Posterior

Lateral

Medial

6. Drainage

jEt

E

=o

CL

e

f

.9

oo

U)

Branch to shaft

of distal phalanx

Digital artery

Branch to base

of distal phalanx

Fig. 9.51: The digital pulp space