Download Normal and variant anatomy of the fascial spaces of the hand and

Normal and variant anatomy of the fascial spaces of the
hand and wrist - an MRI pictorial study.
Poster No.:
C-2243
Congress:
ECR 2014
Type:
Educational Exhibit
Authors:
M. T. Crockett , E. A. Aherne , E. C. Kavanagh ; Dublin/IE,
1
2
1 1
2
Dublin 7/IE
Keywords:
Education and training, Diagnostic procedure, MR,
Musculoskeletal soft tissue, Musculoskeletal bone,
Musculoskeletal joint
DOI:
10.1594/ecr2014/C-2243
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Learning objectives
This pictorial study aims to define and describe the anatomy of the subfascial spaces of
the hand and wrist using 3Telsa MRI and MR arthrography.
Background
Pathological conditions of the anatomical spaces of the hand and wrist such as
compartment syndrome or infection can cause significant morbidity. A detailed
knowledge of the anatomy of these subfascial spaces is essential particularly when
assessing infective conditions which have potential to spread from the hand to forearm
via these anatomic spaces.
Findings and procedure details
Figure 1.
1. Mid palmar space (open arrow) - Lies within intermediate compartment of hand.
Relations; lies between the palmar aponeurosis anteriorly and palmar interossei and
metacarpals posteriorly. Contents; flexor tendons, lumbricals, superficial arterial arch,
nerves and vessels.
2. Thenar space (closed arrow); Relations; posterior to the long flexor tendons to the
index finger and in front of the adductor pollicus muscle. Contents; contains flexor pollicis
longus, flexor indicis, 1st lumbrical and digital nerves.
Both these spaces are clinically-relevant as potential compartments for infection.
Figure 2.
Hypothenar space (open arrow); Relations; lies superficial to interosseous muscles
medially.Contains no long flexor tendons but does contain the hypothenar muscles.
Figure 3.
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Dorsal subaponeurotic space (open arrow); lies deep to the extensor tendons and above
the periosteum of the metacarpals and dorsal interosseus muscles.
Figures 4. and 5.
Space of Parona (open arrow)- Relations; Roof = flexor digitorum profundus tendons and
flexor digitorum superficialis. Floor = pronator quadratus and interosseous membrane.
Medial wall = flexor carpi ulnaris. Lateral wall = Flexor pollicus longus. Parona's space
extends from proximal aspect of carpal tunnel to mid forearm. It is continuous with the
deep mid palmar space as well as the radial and ular bursae and can allow infections of
the hand to spread proximally into the forearm.
Images for this section:
Fig. 1: Both these spaces are clinically-relevant as potential compartments for infection.
1. Mid palmar space (open arrow) - Lies within intermediate compartment of hand.
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Relations; lies between the palmar aponeurosis anteriorly and palmar interossei and
metacarpals posteriorly. Contents; flexor tendons, lumbricals, superficial arterial arch,
nerves and vessels. 2. Thenar space (closed arrow); Relations; posterior to the long
flexor tendons to the index finger and in front of the adductor pollicus muscle. Contents;
contains flexor pollicis longus, flexor indicis, 1st lumbrical and digital nerves.
Fig. 2: Hypothenar space (open arrow); Relations; lies superficial to interosseous
muscles medially.Contains no long flexor tendons but does contain the hypothenar
muscles.
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Fig. 3: Dorsal subaponeurotic space (open arrow); lies deep to the extensor tendons and
above the periosteum of the metacarpals and dorsal interosseus muscles.
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Fig. 4: Space of Parona (open arrow)- Relations; Roof = flexor digitorum profundus
tendons and flexor digitorum superficialis. Floor = pronator quadratus and interosseous
membrane. Medial wall = flexor carpi ulnaris. Lateral wall = Flexor pollicus longus.
Parona's space extends from proximal aspect of carpal tunnel to mid forearm. It is
continuous with the deep mid palmar space as well as the radial and ular bursae and can
allow infections of the hand to spread proximally into the forearm.
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Fig. 5: Space of Parona (open arrow) - Space of Parona (open arrow)- Relations; Roof
= flexor digitorum profundus tendons and flexor digitorum superficialis. Floor = pronator
quadratus and interosseous membrane. Medial wall = flexor carpi ulnaris. Lateral wall =
Flexor pollicus longus. Parona's space extends from proximal aspect of carpal tunnel to
mid forearm. It is continuous with the deep mid palmar space as well as the radial and
ular bursae and can allow infections of the hand to spread proximally into the forearm.
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Conclusion
A detailed knowledge of the anatomy of the subfascial spaces of the hand and wrist allows
accurate diagnosis of pathology, specifically deep fascial infections which may spread
from the deep fascial spaces of the hand into the forearm via the space of Parona. MRI
is the imaging modality of choice to assess these anatomical saces which this pictioral
study has defined.
Personal information
MT Crockett MB BCh MCh, Radiology registrar.
EA Aherne MB BCh, Radiology registrar.
EC Kavanagh MB BCh, Consultant radiologist
References
1.
2.
3.
4.
5.
Acute compartment syndrome of the forearm secondary to infection within
the space of Parona. Jamil et al. Orthopedics. 2011 Sep 9;34(9).
Greens operative hand surgery. Wolf et al. Elsevier Health Sciences, 27 Sep
2010.
Principles of hand surgery and therapy. Trumble et al. Expert consult, 2nd
edition.
Deep subfascial space infections. Jebson PJ. Hand clinics of North
America.1998 Nov;14(4):557-66.
Space of Parona infections: experience in management and outcomes in a
regional hand centre. Sharma KS et al. Journal of plastic reconstructive and
aestheic surgery. 2013 Jul;66(7):968-72
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