Thenar space
By : Sedra MuhammedIntroduction:
It's part of the facial spaces of the hand specifically the palmar space.
This is a triangular space situated in the thenar region.
• Proximally:
- It extends to the distal margin of the flexor retinaculum.
• Distally:
- It extends to the proximal transverse palmar crease.
- It communicates with the forearm space, subcutaneous web of the thumb through the fascial sheath of the first lumbrical muscle.
- It may also communicate with the second lumbrical canal.
This is a triangular space situated in the thenar region.
• Proximally:
- It extends to the distal margin of the flexor retinaculum.
• Distally:
- It extends to the proximal transverse palmar crease
Note
proximal transverse palmar crease: is the crease below the distal palmar crease and is parallel to it.- It communicates with the forearm space, subcutaneous web of the thumb through the fascial sheath of the first lumbrical muscle.
- It may also communicate with the second lumbrical canal.
Boundries:
• Anteriorly – Palmar aponeurosis.
• Posteriorly – Fascia covering the transverse head of the adductor pollicis and the first dorsal interosseous muscle.
• Medially – Intermediate palmar septum.
• Laterally – Lateral palmar septum.
• Posteriorly – Fascia covering the transverse head of the adductor pollicis and the first dorsal interosseous muscle.
• Medially – Intermediate palmar septum.
• Laterally – Lateral palmar septum.
Contents:
• The tendon of the flexor pollicis longus with its synovial sheath;
• The flexor tendons of the index finger
• The first lumbrical muscle
• The palmar digital vessels and nerves of the thumb and lateral side of the index finger.
• The flexor tendons of the index finger
• The first lumbrical muscle
• The palmar digital vessels and nerves of the thumb and lateral side of the index finger.
Clinical notes regarding thenar space infection:
what causes thenar space infection?
The thenar space may be infected by a spread of any infection in the thumb or index finger. This results in marked swelling of the web of the thumb and thenar region.
The thumb is held in an abducted position.
What are the symptoms of thenar space infection?
In thenar space infections a painful swelling of the thenar eminence is observed. The concavity of the palm is lost and often soft edema on the dorsum of the hand is present. The 1st metacarpal and the thumb are abducted and distal phalanx flexion becomes more marked.
How to treat a thenar space infection?
In extensive infections, a double incision over the palmar and dorsal side is necessary for drainage of the infected spaces.
Note: because of the intimate relationship of the midpalmar and the thenar spaces, any infection persisting for more than 48 hours extends in the majority of cases to the adjacent space. When both spaces are involved, a considerable abscess is formed under the flexor tendons.
The thenar space may be infected by a spread of any infection in the thumb or index finger. This results in marked swelling of the web of the thumb and thenar region.
The thumb is held in an abducted position.
What are the symptoms of thenar space infection?
In thenar space infections a painful swelling of the thenar eminence is observed. The concavity of the palm is lost and often soft edema on the dorsum of the hand is present. The 1st metacarpal and the thumb are abducted and distal phalanx flexion becomes more marked.
How to treat a thenar space infection?
In extensive infections, a double incision over the palmar and dorsal side is necessary for drainage of the infected spaces.
Note: because of the intimate relationship of the midpalmar and the thenar spaces, any infection persisting for more than 48 hours extends in the majority of cases to the adjacent space. When both spaces are involved, a considerable abscess is formed under the flexor tendons.
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
