Spaces and Compartments of Hand

Spaces of Hand

Deep space infections occur in one of the three anatomically defined potential spaces within the hand.

  1. Thenar, mid-palmar and hypothenar spaces
  2. Interdigital subfascial web space
  3. Forearm space of parona
Deep hand spaceDorsal borderVolar borderUlnar borderRadial borderRemarks
ThenarAdductor pollicisPalmar aponeurosisMiddle palmar septumLateral palmar septumFPL within synovial sheath, FDP and FDS for index finger, 1st lumbrical, Radial bursa, Palmar digital vessels of thumb and lateral side of index finger – these can be considered as contents or volar border
Mid-palmar3rd, 4th and 5th metacarpals with fascia covering 3rd and 4th interosseiPalmar aponeurosisMedial palmar septumMiddle palmar septumFlexor tendons of 3rd-5th fingers, 2nd-4th lumbricals, Superficial palmar arch, Digital nerves and vessels of medial 3 and 1/2 fingers, Ulnar bursa – these can be considered as contents or volar border
Hypothenar5th metacarpalPalmar aponeurosisMedial palmar septumHypothenar muscles
Dorsal subaponeuroticExtensor tendons and dorsal aponeurosisMetacarpals and dorsal fascia of interossei
Interdigital subfascialDorsal hand fascia and skinPalmar fasciaMetacarpophalangeal joint and extensor tendonMetacarpophalangeal joint and extensor tendon
Parona (Forearm space)Digital flexor tendonsPronator quadratusFlexor carpi ulnarisFlexor pollicis longusContinuous with midpalmar space

Incisions:

  1. Mid-palmar space: Curved incision beginning at the level of distal palmar crease, in line with the long finger and extending ulnar-ward to just inside the hypothenar eminence
  2. Thenar space: Curved incision in thumb web parallel to border of the 1st dorsal interossei or along the medial side of thenar crease
hand space infections incisions

Compartments of Hand

Hand comprises of 10 compartments.

CompartmentMusclesFasciotomy Incision
HypothenarAbductor digiti minimi
Flexor digiti minimi
Opponens digiti minimi
Ulnar border of hand
Thenar Abductor pollicis brevis
Oponens pollicis
Flexor pollicis brevis
Radial margin of thenar eminence
AdductorTwo heads of adductor pollicisDorsal over first webspace
Dorsal Interosseous4 compartments​​Between 2-3rd & 4-5th metacarpals
Volar Interosseous 3 compartmentsExtended carpal tunnel incision 

3 Dorsal fasciotomy incisions:

Incision 1: Longitudinal Incision in 1st Webspace

  • First dorsal interosseous muscle (can also release the dorsal fascia of the adductor pollicis)

Incision 2 & 3: Longitudinal Incision in 2nd-3rd, 4-5th Metacarpal space

  • Remaining dorsal interosseous muscles (can also decompression volar interosseus muscles)


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