Potential Spaces of the Hand and Deep Space Infections
DNB Orthopaedics • June 2014 • Paper I • 10 Marks
Introduction
The hand contains several potential fascial spaces that are normally collapsed but can become distended by pus, blood or oedema. Infection in these spaces is clinically important because the rigid fascial boundaries permit rapid pressure rise, tissue ischaemia and spread along tendon sheaths or communicating spaces.
Deep space infection should therefore be regarded as a surgical infection. Delay in drainage can result in tendon necrosis, stiffness, neurovascular compromise, osteomyelitis and permanent loss of hand function.
Core principle
Deep hand infection = early recognition + antibiotics + adequate surgical drainage while protecting tendons, nerves and vascular structures.
Definition of a Potential Space
A potential space is a normally collapsed tissue plane bounded by fascia, septa, muscles, tendons or bones that can become a true space when distended by fluid, blood or pus.
Classification of Potential Spaces of the Hand
Easy anatomical grouping
Palm → Web → Dorsum
| Region | Potential Spaces |
|---|---|
| Palmar deep spaces | Thenar space, Midpalmar space |
| Digital / interdigital spaces | Web spaces |
| Dorsal spaces | Dorsal subcutaneous space, Dorsal subaponeurotic space |
1. Thenar Space
The thenar space is a…