applied anatomy in hand infections

8/9/2019 Applied Anatomy in Hand Infections

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Applied anatomy inhand infections


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Skin

The skin of the dorsum of the hand is thin and p It is attached to the hands skeleton only by loos

areolar tissue, which also contains lymphatics an

This explains why oedema of the hand is manisfpredominantly at the dorsum


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Skin

The skin of the palmar surface is thick, glabrous less pliable

This enhances the skin ability for grasping funct

The skin is most rmly anchored to the deep strat the palmar creases


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Arteries


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eins


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!erves


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"ones

Total #$ bones in the hand and wrist % groups

&arpals

'etacarpals

(halanges


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'uscles and tendons

'uscles of the hand are divided into Intrinsic group

)xtrinsic group


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)xtensors

All extensors are extrinsics and supplied by the ranerve, except for the interosseous*lumbrical comp

% wrist extensors+ )xtensor carpi radialis brevis

)xtensor carpi radialis longus

)xtensor carpi ulnaris igit extensors

)xtensor digitorum communis

)xtensor indicis proprius

)xtensor digit minimi


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Thumb extensors Abductor pollicis longus

)xtensor pollicis brevis

)xtensor pollicis longus


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)xtrinsic -exors

% wrist -exors .lexor carpi radialis

.lexor carpi ulnaris

(almaris longus

igital -exors

.lexor digitorum supercialis .lexor digitorum profundus

.lexor pollicis longus


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Intrinsics

Situated totally within the hand ivided into / groups

Thenar

0ypothenar

1umbricals

Interossei muscles


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Spaces of the hand

Important spaces are Supercial pulp spaces of the nger

Synovial tendon sheaths of the nger

2lnar bursa

3adial bursa

'idpalmar spaceThenar space


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Supercial pulp space

The pulp space is a closed fascial compartment in front of the distal phalanx of each nger

)ach space is divided into multiple smallercompartments by brous septa


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Accumulation of exudate within these compartmcauses a 4uick rise the pulp space pressure

In children, pressure on the blood vessels may lenecrosis of the diaphysis

The proximal end of the pulp space is closely rel

the digital synovial sheath, hence infection may between these two spaces


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Synovial tendon sheaths of thenger


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3adial and ulnar bursa

3adial bursa 5synovial sheath of the -exor polliclongus6

2lnar bursa 5common -exor synovial sheath6

3adial bursa communicates with the ulnar bursasome people


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Thenar space

The thenar space lies 7ust supercial to the addupollicis muscle, forming a plane connecting the daspect of the radial bursa and ulnar bursa

Abcsess may spread through the thenar space dthe palm between the thumb and carpal tunnel


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'idpalmar space

The midpalmar space contains the #nd, %rd, andlumbrical muscles and lies posterior to the long tendons to the middle, ring and little ngers8 It lfront of the interossei and the %rd, /th and 9thmetacarpal bone

Infection of the midpalmar space may result fromtenosynovitis of the middle and ring ngers or frweb infection which has spread proximally throulumbrical canals8

:hen this happens the normal concavity of the obliterated and the swelling extends to the dorsu

the hand8


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applied anatomy in hand infections

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