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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.


 

 

Features

Midpalmar space

Thenar space

1. Shape

Triangular.

Triangular.

2. Situation

 

Under the inner half of the hollow of the palm.

Under the outer half of the hollow of the palm.

3. Extent
Proximal

Distal

 

Distal margin of the flexor retinaculum.

Distal palmar crease.

 

Distal margin of the flexor retinaculum.

Proximal transverse palmar crease.

4. Communications
Proximal

Distal

 

Forearm space.

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

 

Fascial sheath ofthe first lumbrical,
occasionally 2nd.

 

5. Boundaries
Anterior

 

 

 

Posterior

 

 

Lateral

 

Medial

 

 

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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