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Palmar Fascial Spaces

  1. Three fascial lined potential spaces limited by fibrous septa warrant attention in the palm and the palmar aspect of terminal phalanges, because of their surgical importance. These are mid-palmar space, thenar space and pulp spaces.
  2. The central hollow of the palm between the thenar and hypothenar eminences is occupied by palmar aponeurosis, long flexor tendons covered by synovial sheaths (i.e. radial and ulnar bursa), and lumbricals muscles. Deep to these flexor tendons and lumbricals there lies a large fascial lined central palmar space which is limited at the sides by the medial and lateral palmar septa. The space is subdivided by intermediate palmar septum into mid palmar space (on ulnar side) and the thenar space on radial side.




Midpalmar space

Thenar space

1. Shape



2. Situation


Under the inner half of the hollow of the palm.

Under the outer half of the hollow of the palm.

3. Extent



Distal margin of the flexor retinaculum.

Distal palmar crease.


Distal margin of the flexor retinaculum.

Proximal transverse palmar crease.

4. Communications



Forearm space.

Fascial sheaths of the 3rd and
4th lumbricals; occasionally 2nd.


Fascial sheath ofthe first lumbrical,
occasionally 2nd.


5. Boundaries












Flexor tendons of3rd, 4th, and 5th fingers

2nd, 3rd and 4th lumbricals, Palmar aponeurosis



Fascia covering interossei and metacarpals.



Intermediate palmar septum


Medial palmar septum



Short muscles of thumb.

Flexor tendons of the index finger.
First lumbricals, Palmar aponeurosis.


Transverse head of adductor pollicis.



Tendon of flexor pollicis longus withradial bursa.

Lateral palmar septum.
Intermediate palmar septum.

6. Drainage

Incision in either the 3rd or 4th web space.

Incision in the first web space.

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