FASCIAL SPACES OF

HAND
 FASCIAL SPACES OF HAND :
 These are the potential spaces filled with loose connective
tissue but they became obvious only when fluid or pus
collects in them. These spaces are of surgical important.
The knowledge of their boundaries is important because
they may limit the spread of infection in the hand
 Types of spaces :
 1. Mid palmar space
 2. Thenar space
 3. Pulp spaces of digits
 Boundaries:
 1. Mid palmar space :
 ANT: a) palmar apo, b) superficial palmar arch, c) digital
vessels and nerves supplying medial 3½ fingers d) ulnar
bursa flexor tendons of medial 3 fingers.
e) medial 3 lumbricals .
 POST: a) palmar and dorsal interossei,
 b) medial 3 metacarpals.
 LATE: Intermediate palmar septum extending obliquely
from medial edge of palmar aponeurosis to the 3rd
metacarpal bone.
 MED: Medial palmar septum extending from medial edge
of PA to the 5th meta carpal bone.
 PROXIMAL: Mid palmar space is continuous with forearm
space of parona.
 DISTAL: This space is continuous with medial 3 web
spaces through medial 3 lumbrical canals
 Mid Palmar Space –

- Triangular in shape
 Boundary
- InFront
- Behind
- Laterally
- Medially
- Proximally
- Distally
 Thenar Space
- Triangular in Shape
 Boundary
- In Front
- Laterally
- Medially
- Proximally
- Distally
 Boundaries:
 2. Thenar space : It is located under the outer half of the
hollow of the palm
 ANT: a) PA(lateral part) b) Digital nerve and vessels of
lateral 1½ digits c) radial bursa contains tendon of F.P.L
d) Flexor tendons of index finger e) 1st lumbrical.
 LAT: Lateral palmar septum extending from lateral edge
of palmar aponeurosis to the 1st metacarpal bone.
 MED: Intermediate palmar septum
 POST: Fascia covering the abductor pollicis
 PROX: This space is limited by fusion of anterior and
posterior walls in the carpal tunnel.
 DISTAL: The space communicate with the 1st web space
through the 1st lumbrical canal.
 3. Pulp spaces of the digits:
 These are subcutaneous spaces on the palmar side of the
tips of fingers and thumb. The pulp space is filled with
subcutaneous fatty tissue
 Boundaries :
 Superficially : Skin and superficial fascia
 Deeply : Distal 2/3rd of distal phalanx
Features:
1.The space is traversed by numerous fibrous septa extending from
skin to the periosteum of the terminal phalanx, dividing it into
many loculi
2.The deep fascia of pulp of each finger fuses with the periosteum
of terminal phalanx distal to the insertion of long flexor tendon.
3.The digital artery that supplies the diaphysis of phalanx runs
through this space. The epiphysis of distal phalanx receives its
blood supply proximal to the pulp space.

 Web spaces:
 The web space is a subcutaneous space in each interdigital
cleft and is filled with loose areolar tissue. It contains
lumbrical tendon, interosseous tendon, digital nerve and
vessels
 The web space extends from the free margin of the web,
as for proximally as the level of transverse metacarpal
ligaments.
 APPLIED ANATOMY:
 The ulnar bursa is considered as the inlet for infection and
lumbrical canals as the outlets of infection in midpalmar space.
 The pus from this space is drained by incisions in the medial
two web spaces.
 The infected radial bursa sends infection to the thenar space.
The pus from thenar space is drained by an incision in the first
web space.
 The digits of the pulp spaces are more prone for infection. An
abcess in the pulp space is called whitlow or felon. The pus
from pulp space is drained by a lateral incision, opening all
loculi and avoiding tactile skin sensation on the front of the
finger.
 If neglected the whitlow may lead to avascular necrosis of
distal 4/5th of terminal phalanx due to block of digital artery as
a result of pressure. Proximal 1/5th phalanx is not affected
because digital artery branch does not pass through pulp
space.
Surgical incisions to drain pus
in the spaces:
1.To drain pus in the thenar space,
a vertical incision is given in the 1st web
space ‘A’
2. To drain pus from mid palmar space a
small vertical incision in the medial two
web spaces ‘B’
3. For ulnar bursa incision along the radial
margin of hypo thenar eminence ‘C’
4. For radial bursa incision along the medial
margin of thenar eminence ‘D’
5. For digital synovial sheath vertical
incision along the side of proximal and
middle phlanges ‘E’
6. For pulp space incision should be given
along the sides of pulp ‘F’
7. For space of parona, vertical incision
should be given on the distal part of
forearm ‘G’
 Spaces on the dorsum of hand: Potential spaces
 dorsal sub cutaneous space, - lies deep to the skin on the dorsum of hand.
 dorsal sub aponeurotic space,- Extensor tendons on the dorsum of hand along
with deep fascia of the dorsum of hand forms an aponeurotic sheath which is
attached to the borders of 2nd and 5th metacarpals. The space between in
dorsal surface of medial 4th metcarpal and interosseous muscles anteriorly and
aponeurotic sheath posteriorly is called dorsl sub aponeurotic space. The space
is limited proximally at the bases of metacarpals and distally at the
metacarpophalangeal joints by fibrous partitions.
 Applied anatomy:
 Infection of subcutaneous space is very rare but some times the
space get infected after injury over the knuckles.
 Knuckles--The bony prominences at the junction of hand and digit
which become visible prominently when a fist is made. They are
produced by the heads of metacarpals.
 Collection of pus in this space produces large swelling due to
looseness of skin. The pus points through the skin and can be
drained by incision given at the pointing site.
 The septic infection of sub aponeurotic space is generally primary
following wounds on the dorsum of hand.
 It may be secondary to the infection of the mid palmar space.
END