Pulp spaces of the fingers
By : Sedra MuhammedIntroduction
It's part of the facial spaces of the hand specifically the palmar space.
Fat in the tips of fingers and thumb contain subcutaneous fat which is arranged in light compartments formed by fibrous septa. These septae pass from the skin to the periosteum of the terminal phalanx, For this reason, fluid or pus in this area have no space to drain because of the tight septae.
Fat in the tips of fingers and thumb contain subcutaneous fat which is arranged in light compartments formed by fibrous septa. These septae pass from the skin to the periosteum of the terminal phalanx, For this reason, fluid or pus in this area have no space to drain because of the tight septae.
Boundries
Anteriorly: bounded by the skin and superficial fascia.
Posteriorly:bounded by the distal 2/3rd of distal phalanx.
Terminal branches of the digital artery course through the pulp spaces to supply the diaphysis of distal phalanx.
Proximal one fifth of the distal phalanx receives its blood supply by digital arteries which don’t pass through the septa.
Distal four fifths of the distal phalanx receive its blood supply by digital arteries which pass through the septa.
Therefore the distal four fifths of the distal phalanx is prone to avascular necrosis.
Posteriorly:bounded by the distal 2/3rd of distal phalanx.
Terminal branches of the digital artery course through the pulp spaces to supply the diaphysis of distal phalanx.
Proximal one fifth of the distal phalanx receives its blood supply by digital arteries which don’t pass through the septa.
Distal four fifths of the distal phalanx receive its blood supply by digital arteries which pass through the septa.
Therefore the distal four fifths of the distal phalanx is prone to avascular necrosis
Note
Avascular necrosis: it is the death of bone tissue due to a lack of blood supply
Clinical notes regarding pulp spaces
an infection that occurs within the closed-space compartments of the fingertip pulp is called a Felon.
What causes felons?
usual cause is trauma with invasion by bacteria. A felon may develop in the presence of a foreign body, such as a thorn or a splinter.
Staphylococcus aureus is the most common causative organism.
What does a felon do?
A felon behaves like a deep space infection forming an abscess because it is confined within the matrix of vertical fibrous septa in the pulp space, because of these septa, any swelling causes immediate pain that is intensified because of increased pressure within the pulp.
Note: although the septa may facilitate an infection in the pulp, they also provide a barrier that protects the joint space and tendon sheath by limiting proximal spread of the infection.
What happens if felons aren’t treated?
When not treated, the felon may progress to cause:
• tissue necrosisin the pulp space.
• Osteomyelitis (infection of the distal phalanx).
• Tenosynovitis (inflammation of a tendon and its sheath).
• Paronychia (inflammation of folds of the skin surrounding the fingernail).
How to treat a felon?
felons require surgical decompression.
Treatment generally consists of incision and drainage with antibiotics. Early presentation may be treatable with rest, elevation, warm soaks, and antibiotics.
What causes felons?
usual cause is trauma with invasion by bacteria. A felon may develop in the presence of a foreign body, such as a thorn or a splinter.
Staphylococcus aureus is the most common causative organism.
What does a felon do?
A felon behaves like a deep space infection forming an abscess because it is confined within the matrix of vertical fibrous septa in the pulp space, because of these septa, any swelling causes immediate pain that is intensified because of increased pressure within the pulp.
Note: although the septa may facilitate an infection in the pulp, they also provide a barrier that protects the joint space and tendon sheath by limiting proximal spread of the infection.
What happens if felons aren’t treated?
When not treated, the felon may progress to cause:
• tissue necrosis
Note
necrosis: it is the death of body tissue, It occurs when too little blood flows to the tissue.• Osteomyelitis (infection of the distal phalanx).
• Tenosynovitis (inflammation of a tendon and its sheath).
• Paronychia (inflammation of folds of the skin surrounding the fingernail).
How to treat a felon?
felons require surgical decompression.
Treatment generally consists of incision and drainage with antibiotics. Early presentation may be treatable with rest, elevation, warm soaks, and antibiotics.
Case of Tenosynovitis
case of paronychia
Whitlows
what are whitlows?
Whitlow is another type of infection of the pulp spaces of the fingers, caused by Herpes Simplex type I virus, Whitlows are usually referred to as herpetic whitlows.
What are the symptoms of herpetic whitlows?
• swelling and pain.
• blisters or sores.
• skin becoming red or darker than your usual skin tone.
How to treat herpetic whitlow?
Herpetic whitlow tends to go away in 2–4 weeks without treatment. To reduce the duration of the symptoms, a person may be prescribed antiviral medications.
It’s best to receive treatment within 48 hours of the symptoms appearing.
note: herpetic whitlow is commonly mistaken for paronychia or a bacterial felon.
Whitlow is another type of infection of the pulp spaces of the fingers, caused by Herpes Simplex type I virus, Whitlows are usually referred to as herpetic whitlows.
What are the symptoms of herpetic whitlows?
• swelling and pain.
• blisters or sores.
• skin becoming red or darker than your usual skin tone.
How to treat herpetic whitlow?
Herpetic whitlow tends to go away in 2–4 weeks without treatment. To reduce the duration of the symptoms, a person may be prescribed antiviral medications
Note
antiviral drugs: Antiviral drugs are a class of medication used for treating viral infections.It’s best to receive treatment within 48 hours of the symptoms appearing.
note: herpetic whitlow is commonly mistaken for paronychia or a bacterial felon.
Red and swollen finger caused by herpetic whitlow.
Blisters and sores caused by herpetic whitlow.
References
Bacterial Infections
William D. James MD, in Andrews' Diseases of the Skin, 2020
Hand Infections
Frederick M. Azar MD, in Campbell's Operative Orthopaedics, 2021
Infections of the hand
James Chang MD, in Plastic Surgery: Volume 6: Hand and Upper Extremity, 2018
Incision and Drainage
James R. Roberts MD, FACEP, FAAEM, FACMT, in Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 2019
national library of medicine
closed spaces hand infections: diagnostic and treatment consideration, 2012
Gathier PJ, Schönberger TJ. A man with an infected finger: a case report. J Med Case Rep. 2015
William D. James MD, in Andrews' Diseases of the Skin, 2020
Hand Infections
Frederick M. Azar MD, in Campbell's Operative Orthopaedics, 2021
Infections of the hand
James Chang MD, in Plastic Surgery: Volume 6: Hand and Upper Extremity, 2018
Incision and Drainage
James R. Roberts MD, FACEP, FAAEM, FACMT, in Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care, 2019
national library of medicine
closed spaces hand infections: diagnostic and treatment consideration, 2012
Gathier PJ, Schönberger TJ. A man with an infected finger: a case report. J Med Case Rep. 2015
