Deep Palmar Space Infection

Deep Palmar Space Infection

Deep palmar infections are extremely serious; they often lead to diminished hand function. The infected area usually lies deep to the flexor tendons and lumbricals, but superficial to the metacarpals and their muscles, the adductor pollicis and the interossei.

The central compartment of the palm is subdivided by a septum of fascia that arises from the fascia surrounding the flexor tendons of the

middle finger and attaches to the third metacarpal. The area on the lateral side of the septum sometimes is called the thenar space, and the area on the medial side is called the midpalmar space. In this text, the terms lateral space and medial space are used, because the term thenar space can be confusing, as this area has nothing to do with the space that is occupied by the thenar muscles of the thenar eminence (Fig. 5-79; see Fig. 5-41).

Infections of the medial space cause local pain, tenderness, and swelling of the palm. The middle and ring fingers lose their ability to move actively, and moving them passively produces severe pain. The hand is grossly swollen, resembling an inflated rubber glove.

Infections of the lateral space produce symptoms and signs similar to those of infections of the medial space, but the index finger and thumb are the digits that lose the ability to move.

Deep palmar infections are among the rarest encountered in hand surgery. These deep infections are being seen more frequently now, however, primarily because of the increase in drug addiction. More than any other infection in the hand, they can cause systemic illness associated with high fevers.

 

 

 

Figure 5-79 Within the central compartment of the palm, a potential deep space

exists between the undersurface of the flexor tendons and the upper surfaces of the interossei and adductor pollicis muscles. This deep palmar space is subdivided into medial midpalmar and lateral thenar spaces by the oblique septum that arises from the connective tissue surrounding the middle finger flexor tendons and runs to the palmar surface of the middle metacarpal. Infections involving the web space may travel along the lumbrical muscle to enter these two potential spaces.