Facial Spaces In The Palm PDF

anatomy of upper limb Facial Spaces In The Palm By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Objectives: by the end of this lecture the student must understand the following knowledge:...

anatomy of upper limb Facial Spaces In The Palm By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Objectives: by the end of this lecture the student must understand the following knowledge:  Identify and demonstrate the following: By Dr. Hassan Rezk UPPER LIMB 1)Synovial Flexor Sheath. 2)Osseo-fibrous tunnel of fingers. 3)Compartments of hand. 4)Spaces of the hand. Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 2  Case Study By Dr. Hassan Rezk UPPER LIMB Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 3  Introduction: Palm of the hand contains several Potential fascial spaces. Potential fascial spaces of the palm are important because they may become infected. By Dr. Hassan Rezk Potential fascial spaces of the palm determine direction of spread of pus formed by these infections. UPPER LIMB Depending on the site of infection, pus will accumulate in: 1) Thenar. 2) Hypothenar. 3) Mid-palmar. 4) Adductor compartments. Antibiotic therapy (treated cases) has made the spread of infections rare. Untreated infection can spread proximally through the carpal tunnel into the forearm. Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 4  Objective 1: Synovial Flexor Sheaths  Function: allow the long tendons to move smoothly, with a minimum of friction. By Dr. Hassan Rezk A. Flexor digitorum superficialis and profundus tendonds invaginate a common synovial sheath from the lateral side known as UPPER LIMB ulnar bursa. It has: 1) The medial part: extends continuous distally around the tendons of the little finger. 2) The lateral part: stops abruptly on the middle of the palm, and the distal ends of the long flexor tendons of the index, the middle, and the ring fingers new have separate digital synovial sheaths will be formed. B. Flexor pollicis longus tendon: has its own synovial sheath that passes into the thumb known as radial bursa. Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 5 By Dr. Hassan Rezk UPPER LIMB Closed carpal tunnel Open carpal tunnel Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 6 By Dr. Hassan Rezk UPPER LIMB Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 7  Objective 2: Osseo-fibrous tunnel of fingers. (1) Outer: Fibrous Flexor Sheath (2) Inner: Synovial Digital Sheath By Dr. Hassan Rezk  Site: Palmar surface of each finger along its whole length. UPPER LIMB  Attachments: o The sides are attached to the sides of the phalanges. o The proximal end is open. o The distal end is closed and is attached to the base of the distal phalanx.  The sheath and the bones form a blind tunnel in which the flexor tendons of the finger lie. Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 8 By Dr. Hassan Rezk UPPER LIMB B Osseo-fascial tunnel of a finger A: (Palmar (flexor) View) B: Cross Section A Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 9  Objective 3: Compartments of hand. Compartments of Hand Spaces of Hand By Dr. Hassan Rezk UPPER LIMB ① Thenar compartment ① Thenar space ② Hypothenar compartment ② Midpalmar space ③ Central compartment ④ Adductor compartment Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 10  Septa of Palmar Aponeurosis 1) Medial fibrous septum: which extends By Dr. Hassan Rezk UPPER LIMB from the medial border of the palmar aponeurosis to the 5th metacarpal. 2) Lateral fibrous septum: which extends from the lateral border of the palmar aponeurosis to the 3rd metacarpal. Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 11  Objective 3: Compartments of hand. By Dr. Hassan Rezk 1)Hypothenar compartment: UPPER LIMB  Site: It lies medial to medial fibrous septum.  Contents: hypothenar muscles. 2)Thenar compartment :  Site: It lies lateral to lateral fibrous septum.  Contents: thenar muscles. Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 12  Objective 3: Compartments of hand. 3)Central compartment: By Dr. Hassan Rezk  Site:  Between the hypothenar and the thenar compartments. UPPER LIMB  Is Bounded anteriorly by the palmar aponeurosis.  Contents: 1. Flexor tendons and their sheaths. 2. Lumbricals. 3. Superficial palmar arterial arch. 4. Digital vessels and nerves. 4)Adductor compartment:  Site: The deepest muscular plane of the palm.  Contents: adductor pollicis. Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 13 By Dr. Hassan Rezk Central Compartment UPPER LIMB Thenar compartment Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 14 By Dr. Hassan Rezk UPPER LIMB Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 15  Objective 4: Spaces of hand. Palm Spaces of the Hand Filled with loose connective tissue (potential spaces). By Dr. Hassan Rezk 1.Thenar space 2. Midpalmar space UPPER LIMB lateral to the lateral fibrous septum. medial to the lateral fibrous septum. Anteriorly: Anteriorly: 1. Long flexor tendons to the index finger. 1. Long flexor tendons to the middle, ring, little 2. 1st lumbrical muscle fingers. Site 2. 2nd , 3rd & 4th lumbrical muscles. Posteriorly: Adductor pollicis muscle in adductor Posteriorly: compartment. 1.Interossei. 2.3rd , 4th , and 5th metacarpal bones.  Proximally: the thenar and midpalmar spaces are closed off from the forearm by carpal Extension tunnel.  Distally: the two spaces are continuous with the appropriate lumbrical canals Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 16 By Dr. Hassan Rezk UPPER LIMB Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 17 By Dr. Hassan Rezk UPPER LIMB Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 18 By Dr. Hassan Rezk Parona space  Potential space. Site: UPPER LIMB   In the distal forearm.  Deep to the flexor tendons in carpal tunnel.  Superficial to the pronator quadratus muscle.  Infection in Parona space usually the result of spread from: 1. Midpalmar space. 2. Radial or ulnar bursae. Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 19  Clinical Correlation Fascial Spaces of the Palm  They can become infected and distended with pus as a By Dr. Hassan Rezk result of: UPPER LIMB 1. Spread of infection in acute suppurative tenosynovitis. 2. Penetrating wounds such as falling on a dirty nail.  Untreated infection can spread proximally from the midpalmar space through the carpal tunnel into the forearm, anterior to the pronator quadratus (Parona Space). Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 20  Clinical Correlation Tendosynovitis By Dr. Hassan Rezk UPPER LIMB  Cause: Rusty puncture.  Symptoms: The digit swells and movement becomes painful.  Infection may spread to the midpalmar space. Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 21  Case Scenario By Dr. Hassan Rezk A 34-year-old woman comes to the physician because of a 3-month history of pain in her right thumb and wrist that radiates to her elbow. It is worse when she holds her infant son and improves with the use of an ice pack. Six months ago, she slipped on a wet floor and fell UPPER LIMB on her right outstretched hand. Her mother takes methotrexate for chronic joint pain. The patient takes ibuprofen as needed for her current symptoms. Examination of the right hand shows tenderness over the radial styloid with swelling but no redness. There is no crepitus. Grasping her right thumb and exerting longitudinal traction toward the ulnar side elicits pain. Range of motion of the finger joints is normal. There is no swelling, redness, or tenderness of any other joints. Which of the following is the most likely diagnosis? A. Skier's thumb B. De Quervain tenosynovitis C. Swan neck deformity D. Mallet finger E. Carpal tunnel syndrome. MRI Findings Across the wrist region By Dr. Hassan Rezk September 14, 2024 22 By Dr. Hassan Rezk UPPER LIMB End of Upper Limb Course In M1-Cognition and Action Effects of fall on outstretched hand By Dr. Hassan Rezk September 14, 2024 23  Reference By Dr. Hassan Rezk  Gray's anatomy for students, 3rd edition. UPPER LIMB  ISBN: 978-0-7020-5131-9  Copyright© 2015, 2010, 2005 by Churchill Livingstone, an imprint of Elsevier Inc.  Chapter 7 Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 24 By Dr. Hassan Rezk UPPER LIMB Fascial spaces in the hand By Dr. Hassan Rezk September 14, 2024 25 By Dr. Hassan Rezk UPPER LIMB Effects of fall on outstretched hand By Dr. Hassan Rezk September 14, 2024 26