Palmar Space

Prof YAMA O.E.

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Outline
• Introduction (List of Hand Spaces)
• Spaces of the Hand:
–Boundaries, Extent,
Communications
–Content
–Applied/Clinical Anatomy

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 Introduction: Hand Spaces
• They are potential spaces of the hand
which are of surgical anatomical
significance because they get infected &
becomes distended with pus
• The boundaries & communications may
help limit or promoted the spread of
infections.

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List of Hand Spaces: Introduction: =Continue=
• A. Forearm Space (distal forearm / volar wrist):
– Space of Parona
• B. Hand Spaces:
– Palmar Spaces:
• Thenar Space
• Mid-Palmar Space
• Hypothenar Space
• Web (interdigital) Space
– Fingers:
• Superficial Pulp (perionychium) Spaces of
Fingers
– Dorsal Space of hand:
• Dorsal subaponeurotic space
• Dorsal subcutaneous space 4
Introduction: =Continue=
• Forearm Space (distal forearm /
volar wrist):
–Space of Parona
 Space of Parona:
• Is a potential space in the distal forearm / volar
wrist, deep to flexor tendons.
• It lies between the fascia of pronator quadratus
muscle & the flexor digitorum profundus tendon
sheath

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–Palmar Spaces:
a) Thenar Space
b) Mid-Palmar Space
c) Hypothenar Space
d) Web (Interdigital) Space
(a)Thenar Space
– Shape: triangular
– Location: Under lateral half of the hollow of the palm
– Boundaries:
o Ventral: Palmar aponeurosis
o Dorsal: Adductor pollicis (transverse head) & covering deep
fascia
o Medial: Intermediate palmar septum
o Lateral: Lateral palmar septum
– Extent:
o Proximally: Distal margin of Flexor retinaculum
o Distally: Proximal transverse palmar crease
– Communication:
o With the web space between thumb
(proximally) & index finger (distally)
– Contents:
o Long flexor tendons of thumb & index finger
o First (lateral) lumbrical muscle
o Digital nerves & vessels to lateral 1.5 digits.
– Drainage of pus in the space: By an incision in the first
web space 9
(b) Mid-palmar space – Shape: triangular
– Location: Under the medial
half of the hollow of palm
– Boundaries:
o Ventrally: Palmar aponeurosis
o Dorsally: 3rd, 4th & 5th
metacarpal bones
o Medially: Medial palmar
septum
o Laterally: Intermediate palmar
septum

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– Extent:
oProximally: Flexor retinaculum (distal margin)
oDistally: Distal palmar crease
– Communication:
oProximally: with the space of Parona in the forearm
oDistally: with the webs between the medial-4 fingers
– Contents:
oTendon of the flexor digitorum superficialis &
profundus to medial 3 fingers
oMedial 3 lumbrical muscles
oDigital nerves & vessel to medial 3.5 fingers.
– Drainage of pus in the space: By an incision in the
3rd of 4th web
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 (c) Hypothenar space
• Is one of deep palmar spaces of the hand.
• Relations & boundaries:
– Medial: Hypothenar septum (between
medial surface of flexor retinaculum to
palmar border of 5th metacarpals)
– Lateral: Hypothenar muscles (medial
border)
– Proximal: Flexor retinaculum
– Distal: Hypothenar muscles (distal margin)
– Ventral (Volarly): Hypothenar fascia
– Dorsal: 5th Metacarpal
• Contents: Unlike thenar & midpalmar
space, no long flexor tendons of the
digits traverse the area. It contains
hypothenar muscles.
• It is rarely a site of infection.
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(d) Web Spaces
– These are potential
spaces surrounding
the tendon of each
lumbricals muscle
– They occur between the
pollex, index, middle,
ring & little fingers
– Communication: It is
proximally continuous
with one of the palmar
spaces (mid palmar
spaces)
– Content: Normally
filled with connective 14

tissue
–Dorsal Spaces:
a) Dorsal subaponeurotic
space
b) Dorsal subcutaneous
space
(a) Dorsal subcutaneous space

– Location: The dorsum of the hand between the skin

(superficially) & extensor tendons (deeply)
– Shape: Triangular
– Extent: Extensive
– Contents: Dorsal venous & Dorsal digital nerves & vessels
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(b) Dorsal subaponeurotic space
–Location: Between the extensor tendons
(superficially) & the metacarpals &
interosseous membrane (deeply)
–Shape: Triangular
–Extent: Extensive

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–Fingers:
•Superficial Pulp
(perionychium) Spaces of
Fingers
 Pulp spaces
– Deep fascia of pulp of the finger closes off a fascial
compartment called pulp space.
– Many fibrous septa subdivide the pulp space by passing
from the deep fascia to fuse with the periosteum of
terminal phalanx.
– Content: (a) Is filled with fat, (b) it has the terminal
branch of the digital artery running through supplying
the diaphysis of terminal phalanx. The digital artery
branch to the epiphysis of the distal phalanx does so
proximal to the pulp space
– Pulp space infection (felon)*

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• *Clinical anatomy (more details of felon)
• The pulp of the finger is found anterior to the terminal
phalanx of each finger. It is a closed fascial compartment.
Infection of the space is common following a breach of the
skin of the pulp via pin prick or needle pricks.
• The numerous septa subdividing the pulp space, the
accumulation of inflammatory exudates due to bacterial
infections create pressure in the pulp space. The terminal
phalanx can be infected if the pressure is not quickly
relieved by drainage of the pus.
• In children, the blood supply to diaphysis of the phalanx
passes through the pulp space, & pressure on the blood
vessels could result in necrosis of the diaphysis.
• The epiphysis of the bone is spared as its blood supply is
located proximal to the pulp space.
• The digital synovial sheath can be affected as a result of the
close relationship with the proximal end of the pulp space.
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THE END

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• Summary of Spaces of the Hand

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