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Thenar Space Infections


- See: Infections of the Hand

- Anatomy:
    - extends mediolaterally from long metacarpal bone to the thenar eminence;
    - extends proximodistally from transverse carpal ligament to just proximal to superfical palmar arch;
    - borders of the thenar space include:
            - adductor pollicis dorsally;
            - index finger flexor tendons volarly;
            - midpalmar septum ulnarly;
    - thenar bursae minimizes friction between adductor pollicis & index finger tendons & thenar eminence;
    - dorsal extension of the thenar bursa makes smoother the movements between adductor pollicis and the first dorsal interosseous, index metacarpal bone, and the first palmer interosseous;

- Tenosynovitis:
    - suppurative tenosynovitis of index finger tendon sheath can rupture through its proximal end into the thenar bursae to cause thenar space abscess;
    - thenar/mid palmar space infections;
         - severe pain;
         - swelling
         - fullness of web space;
         - abscess is deep to flexor tendons, and dorsal extension of abscess may be deep to the adductor pollicis;

- Treatment:
    - consider using a combined palmar and dorsal approach to thenar space;
    - palmar incision:
            - make a transverse incision just proximal to MP flexion crease;
            - avoid cutaneous nerves;
            - w/ misquito clamp spread between metacarpals;
    - dorsal incision:
            - longitudinal incision is made on the dorsal aspect of the web between the thumb and index finger;
            - spread to decompress the space behind the adductor pollicis and along the proximal radial aspect of 1st interosseous;
    - closed suction irrigation:
            - this technique has been used in that past, but is used less frequently at present because it is uncomfortable for the patient and time intensive for the nursing staff;
            - technique:      
                    - insert and secture 14 gauge catheter into palmar wound;
                    - loosely close palmar wound, and insert wick into dorsal wound;
                    - design bulky dressing so that it can be partially changed every shift;
                    - run D5LR at 50 cc/hour;
                    - second look in 48 hours

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