Anatomy And Infection Pathways Of The Midpalmar Space

Anatomy And Infection Pathways Of The Midpalmar Space

Question 1. Write a short note on the midpalmar space.
Answer.

It is a triangular space located under the inner half of the hollow of the palm.

Midpalmar Space Boundaries

Midpalmar Space Anterior:

From superficial to deep, the structures forming the anterior boundary are the palmar aponeurosis, the superficial palmar arch, the ulnar bursa enclosing the flexor tendons of the middle, ring, and little fingers, and the 2nd, 3rd, and 4th (medial three) lumbricals.

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Midpalmar Space Posterior:

Fascia covering the interossei of the 3rd and 4th spaces.

Midpalmar Space Lateral:

The oblique intermediate palmar septum extends from the palmar aponeurosis to the 3rd metacarpal bone, which separates it from the thenar space.

Midpalmar Space Medial:

The medial palmar septum extends from the palmar aponeurosis to the 5th metacarpal bone, which separates it from the hypothenar muscles.

Midpalmar Space Proximally:

It is continuous with Parona’s space situated deep to the flexor tendons and in front of the pronator quadratus.

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Midpalmar Space Distally:

It continues as extensions around lumbrical canals to the web spaces of the medial three fingers.

Midpalmar Space Applied Anatomy

This space is primarily infected by puncture wounds. It may be involved secondarily due to infection spreading from the digital synovial sheaths of flexor tendons. From here, the infection may spread to Parona’s space. If this space is infected, then there is tenderness in the palm over the area of the midpalmar space and painful flexion of the little, ring, and middle fingers. The pus from the midpalmar space can be drained by an incision into the 3rd or 4th web space, depending on where the pus points.