MANUAL MINORS
Palmar space infections are deep infections located in the fascial compartments of the palm. These infections can occur in two main areas: the thenar space (surrounding the thumb) and the deep palmar space (between the flexor tendons and the metacarpal bones).
They are typically caused by penetrating injuries, trauma, or the spread of nearby infections and are commonly due to bacteria such as Staphylococcus aureus and Streptococcus.
Diagnosis
The diagnosis is clinical and characterised by:
Severe, deep pain in the palm, worsened with movement.
Swelling in the palm or the back of the hand.
Erythema (redness) and tenderness over the infected area.
Limited finger movement due to pain.
In advanced stages, fever and systemic symptoms may develop. X-rays or ultrasounds are used to rule out foreign bodies or bone involvement (osteomyelitis).
Differential Diagnosis
Condition | Key Differences |
|---|---|
Cellulitis | Superficial infection of the subcutaneous tissue without deep fascial compartment involvement. |
Subcutaneous Abscess | Superficial purulent collection with palpable fluctuation, not involving deep spaces. |
Pyogenic Flexor Tenosynovitis | Pain and inflammatory signs along the flexor tendons, with limited active flexion. |
Septic Arthritis | Pain and swelling in a hand joint, without deep fascial space involvement. |
Emergency Management
Immobilisation of the affected hand to prevent the spread of infection.
Administration of intravenous broad-spectrum antibiotics, covering staphylococci and streptococci (such as ceftriaxone, vancomycin, or similar).
Elevation of the hand and application of ice to reduce swelling.
Pain management with non-steroidal anti-inflammatory drugs (NSAIDs) and opioids if necessary.
Imaging studies, such as MRI or ultrasound, to assess the extent of the infection.
Definitive Treatment
Definitive treatment involves urgent surgical drainage of the abscess in the palmar space. Incision and drainage under anaesthesia allow for evacuation of pus and cleaning of the infected space. Continuous irrigation of the infected cavity is recommended to ensure complete cleansing.
Following surgery, antibiotic therapy is continued for 1-2 weeks, depending on the severity of the infection and culture results. Early rehabilitation with physiotherapy is crucial to prevent stiffness and restore full hand function.
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