Hand Spaces and Infection

The arrangement of fascia and the fascial septa in the hand is such that many spaces are formed. These spaces are of surgical importance because they may become infected and distended with pus.

The important spaces are named below:

(A) PALMAR SPACES

1.The pulp space of the fingers
2.The digital synovial sheaths
3.The ulnar bursa
4.The radial bursa
5.The midpalmar space
6.The thenar space

(B) DORSAL SPACES

1.Dorsal subcutaneous space
2.Dorsal subaponeurotic space

(C) THE FOREARM SPACE OF PARONA

1.The pulp space of the 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. Infection s 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 4/5 of the terminal phalanx due to occlusion of the vessels by the tension. The proximal 1/5 (epiphysis) escapes because its artery does not traverse the fibrous septa.