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Questions and Answers
Which potential fascial space does NOT directly involve the location of pus accumulation in case of an infection?
Which potential fascial space does NOT directly involve the location of pus accumulation in case of an infection?
What is the primary function of synovial flexor sheaths in the upper limb?
What is the primary function of synovial flexor sheaths in the upper limb?
In what way are the digital synovial sheaths for the long flexor tendons of the index, middle, and ring fingers different from those of the little finger?
In what way are the digital synovial sheaths for the long flexor tendons of the index, middle, and ring fingers different from those of the little finger?
What complication can arise from untreated infections in the potential fascial spaces of the hand?
What complication can arise from untreated infections in the potential fascial spaces of the hand?
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Which of the following statements about the ulnar bursa is accurate?
Which of the following statements about the ulnar bursa is accurate?
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What may happen if a potential fascial space in the palm becomes infected?
What may happen if a potential fascial space in the palm becomes infected?
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Which of the following is NOT considered one of the compartments in the hand?
Which of the following is NOT considered one of the compartments in the hand?
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What role does antibiotic therapy play in the context of infections in the fascial spaces of the hand?
What role does antibiotic therapy play in the context of infections in the fascial spaces of the hand?
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What structure encloses the flexor tendons of the fingers to form a blind tunnel?
What structure encloses the flexor tendons of the fingers to form a blind tunnel?
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Where is the proximal end of the osseo-fibrous tunnel open?
Where is the proximal end of the osseo-fibrous tunnel open?
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Which of the following compartments is NOT listed among the compartments of the hand?
Which of the following compartments is NOT listed among the compartments of the hand?
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Which space is associated with the Thenar compartment of the hand?
Which space is associated with the Thenar compartment of the hand?
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What is a characteristic of the distal end of the osseo-fibrous tunnel?
What is a characteristic of the distal end of the osseo-fibrous tunnel?
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Which of these structures does the medial fibrous septum extend from?
Which of these structures does the medial fibrous septum extend from?
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What forms the sides of the osseo-fibrous tunnel of the fingers?
What forms the sides of the osseo-fibrous tunnel of the fingers?
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Which structure does NOT contribute to the formation of fascial spaces in the hand?
Which structure does NOT contribute to the formation of fascial spaces in the hand?
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What lies medial to the lateral fibrous septum?
What lies medial to the lateral fibrous septum?
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Which of the following contents is found in the central compartment of the hand?
Which of the following contents is found in the central compartment of the hand?
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Which compartment of the hand is the deepest muscular plane?
Which compartment of the hand is the deepest muscular plane?
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Which space is located lateral to the lateral fibrous septum?
Which space is located lateral to the lateral fibrous septum?
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Which of the following is NOT a content of the central compartment?
Which of the following is NOT a content of the central compartment?
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The hypothenar compartment primarily contains which type of muscles?
The hypothenar compartment primarily contains which type of muscles?
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Which structure bounds the central compartment anteriorly?
Which structure bounds the central compartment anteriorly?
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The midpalmar space is located medial to which structure?
The midpalmar space is located medial to which structure?
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Which muscles are located posteriorly to the long flexor tendons in the hand?
Which muscles are located posteriorly to the long flexor tendons in the hand?
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What is the primary function of the lumbrical muscles?
What is the primary function of the lumbrical muscles?
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Where is the Parona space located?
Where is the Parona space located?
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Which condition is primarily associated with the spread of infection into fascial spaces in the palm?
Which condition is primarily associated with the spread of infection into fascial spaces in the palm?
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What can cause infections in the Parona space?
What can cause infections in the Parona space?
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What anatomical feature separates the thenar and midpalmar spaces from the forearm?
What anatomical feature separates the thenar and midpalmar spaces from the forearm?
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What is the primary cause of infection spread in the fascial spaces of the hand?
What is the primary cause of infection spread in the fascial spaces of the hand?
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Which metacarpal bones are associated with the interossei muscles?
Which metacarpal bones are associated with the interossei muscles?
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What is the primary cause of the symptoms described for the upper limb injury?
What is the primary cause of the symptoms described for the upper limb injury?
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Which symptom is NOT mentioned in the description of the patient's condition?
Which symptom is NOT mentioned in the description of the patient's condition?
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What potential complication can arise from an untreated infection in the hand?
What potential complication can arise from an untreated infection in the hand?
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Which condition is most likely indicated by pain that worsens when holding an infant and improves with ice?
Which condition is most likely indicated by pain that worsens when holding an infant and improves with ice?
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Which diagnosis is characterized by swelling and tenderness at the radial styloid?
Which diagnosis is characterized by swelling and tenderness at the radial styloid?
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Which of the following symptoms would effectively rule out Carpal tunnel syndrome in this patient?
Which of the following symptoms would effectively rule out Carpal tunnel syndrome in this patient?
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What is the likely effect of the patient's history of slipping on a wet floor six months prior?
What is the likely effect of the patient's history of slipping on a wet floor six months prior?
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Which option is least likely to be a treatment for the condition described in the scenario?
Which option is least likely to be a treatment for the condition described in the scenario?
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Study Notes
Anatomy of the Upper Limb: Hand Spaces
- The palm of the hand contains several potential fascial spaces that can become infected.
- Infections can spread in different directions depending on the space involved.
- Infection locations include the thenar, hypothenar, mid-palmar, and adductor compartments.
- Antibiotic therapy has reduced infection spread but untreated infections can spread proximally into the forearm through the carpal tunnel.
Synovial Flexor Sheaths
- Function: These sheaths allow the long tendons of the hand to move smoothly with minimal friction.
-
Ulnar Bursa:
- A common synovial sheath invaginates the flexor digitorum superficialis and profundus tendons from the lateral side.
- The medial part extends distally around the tendons of the little finger.
- The lateral part stops abruptly in the middle of the palm.
- Separate digital synovial sheaths are formed distally for the index, middle, and ring finger tendons.
-
Radial Bursa:
- The flexor pollicis longus tendon has its own synovial sheath that passes into the thumb.
Osseo-fibrous Tunnel of Fingers
- This tunnel is located on the palmar surface of each finger along its entire length.
- It's formed by a fibrous flexor sheath on the outside and a synovial digital sheath on the inside.
- The sides of the tunnel are attached to the phalanges, the proximal end is open, and the distal end is closed and attached to the base of the distal phalanx.
Compartments of the Hand
-
Thenar compartment:
- Lies lateral to the lateral fibrous septum.
- Contains the thenar muscles.
-
Hypothenar compartment:
- Lies medial to the medial fibrous septum.
- Contains the hypothenar muscles.
-
Central compartment:
- Located between the thenar and hypothenar compartments.
- Bounded anteriorly by the palmar aponeurosis.
- Contains flexor tendons, their sheaths, lumbricals, the superficial palmar arterial arch, and digital vessels and nerves.
-
Adductor compartment:
- The deepest muscular plane of the palm.
- Contains the adductor pollicis muscle.
Spaces of the Hand
-
Thenar space:
- Lies lateral to the lateral fibrous septum.
- Contains:
- Long flexor tendons to the index finger
- 1st lumbrical muscle
- Adductor pollicis muscle in the adductor compartment (posteriorly)
-
Midpalmar space:
- Lies medial to the lateral fibrous septum.
- Contains:
- Long flexor tendons to the middle, ring, and little fingers
- 2nd, 3rd, and 4th lumbrical muscles
- Interossei and 3rd, 4th, and 5th metacarpal bones (posteriorly)
-
Parona space:
- A potential space located in the distal forearm.
- Lies deep to the flexor tendons in the carpal tunnel and superficial to the pronator quadratus muscle.
- Infections usually spread from the midpalmar space or radial/ulnar bursae
Clinical Correlation
- Infections of the hand spaces can result from:
- Spread of infection during acute suppurative tenosynovitis.
- Penetrating wounds (e.g., falling on a dirty nail).
- Untreated midpalmar infections can spread proximally through the carpal tunnel into the forearm (Parona space), anterior to the pronator quadratus muscle.
Tendosynovitis
- Cause: Rusty puncture wounds.
- Symptoms: Digit swelling and painful movement.
- Infection can spread to the midpalmar space.
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Description
This quiz explores the anatomy of the upper limb, focusing on the hand spaces and synovial flexor sheaths. You'll learn about the various fascial spaces, their role in infections, and the function of synovial sheaths for tendon movement. Test your knowledge on these essential anatomical concepts.
