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Fascial spaces are potential spaces formed between the deep fascia, tendons, and muscles of the palm and dorsum of the hand.
These spaces allow free movement of structures during hand activity but can become dangerous sites for pus accumulation in infections.
Knowledge of fascial spaces is crucial because hand infections can spread rapidly through these compartments, often requiring early drainage to prevent functional loss.
Found in the palmar aspect of each finger tip between skin and bone.
Boundaries:
Anterior: Skin and fibrous septa.
Posterior: Distal phalanx (bone).
Clinical Note:
Whitlow (felon): Infection of pulp space → severe throbbing pain due to tight septa → may cause osteomyelitis of distal phalanx.
Located beneath the thenar muscles, on the lateral side of the mid-palmar septum.
Boundaries:
Anterior: Flexor tendons and palmar fascia.
Posterior: Adductor pollicis.
Medial: Mid-palmar septum.
Lateral: Thenar muscles.
Contents:
Tendons of flexor pollicis longus and flexor tendons of index finger with their synovial sheaths.
Communications:
Proximally with the radial bursa (sheath of FPL).
May communicate with space of Parona in the forearm through the carpal tunnel.
Located deeper and medial to the thenar space.
Largest space of the palm.
Boundaries:
Anterior: Flexor tendons of middle, ring, and little fingers.
Posterior: Interossei and third–fourth metacarpals.
Lateral: Mid-palmar septum.
Medial: Hypothenar muscles.
Contents:
Portions of flexor tendons of middle, ring, and little fingers with lumbricals.
Deep palmar vessels and digital nerves.
Communications:
Proximally with the space of Parona (between pronator quadratus and flexor tendons in forearm).
Distally with lumbrical canals toward web spaces.
Found beneath hypothenar muscles, on medial side of palm.
Boundaries:
Anterior: Palmar skin and fascia.
Posterior: Fifth metacarpal and its interosseous muscle.
Contents:
Hypothenar muscles (abductor, flexor, opponens digiti minimi).
Clinical Note:
Infections here remain localized due to strong fibrous septa.
Found on dorsum of hand beneath extensor tendons.
Boundaries:
Anterior: Dorsal interossei and metacarpal bones.
Posterior: Deep fascia and extensor tendons.
Communications:
With intermetacarpal clefts, allowing pus to track between fingers.
Potential space in lower forearm, between flexor tendons and pronator quadratus.
Communicates with thenar and mid-palmar spaces through the carpal tunnel.
Clinical Note:
Common site of extension of palmar infections (especially from ulnar or radial bursae).
Infections can spread through continuity of synovial sheaths and fascial spaces:
Thumb infection → radial bursa → thenar space → Parona’s space.
Little finger infection → ulnar bursa → mid-palmar space → Parona’s space.
Leads to hourglass-shaped abscess across wrist and forearm.
Severe pain and swelling of palm (especially on flexion).
Tenderness along infected compartment.
Finger flexion fixed, dorsal hand appears puffy (due to dorsal spread).
Fever and loss of grip strength common.
Thenar space abscess: Incision along lateral border of thenar eminence.
Mid-palmar space abscess: Incision along medial palmar crease (avoiding digital nerves).
Pulp space abscess: Longitudinal incision on lateral side of finger.
Parona’s space abscess: Drainage via incision above flexor retinaculum.
| Site | Main Involved Finger(s) | Common Communication |
|---|---|---|
| Thenar space | Thumb, index | Radial bursa |
| Mid-palmar space | Middle, ring, little | Ulnar bursa |
| Pulp space | Single digit | None |
| Parona’s space | Forearm extension | Thenar & mid-palmar spaces |
MRI/ultrasound used to localize deep palmar abscesses.
Early fasciotomy and drainage essential to preserve hand function.
Delay → fibrosis → loss of fine movements and contractures.
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