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Updated: May 23 2021

Deep Space & Collar Button Infections

Images hand 2.jpg space.jpg spaces.jpg hand.jpg
  • Introduction
    • Deep space infections
      • defined as infections of the
        • thenar space
          • most commonly infected
        • hypothenar space
        • midpalmar space
          • rare
    • Collar button abscess
      • an abscess that occurs in the web space between fingers
  • Anatomy
    • Thenar space
      • a bursa (potential space) just palmar to adductor pollicis and dorsal to flexor tendons
      • separated from midpalmar potential space by a fascial septum
    • Midpalmar space
      • located dorsal and radial to hypothenar space
    • Hypothenar space
      • located palmar to fifth metacarpal, dorsal and radial to hypothenar fascia, ulnar to hypothenar septum
  • Presentation
    • History
      • may or may not have penetrating trauma
    • Symptoms
      • pain
      • swelling
    • Physical exam
      • pain with flexion of fingers
        • thenar
          • pain with thumb flexion
        • hypothenar
          • pain with small finger flexion
        • midpalmar
          • pain with middle, ring, and small finger flexion
      • thenar and midpalmar spaces
        • often have loss of palmar concavity secondary to swelling
  • Imaging
    • Radiographs
      • indicated if there is suspicion for a foreign body
    • MRI
      • indications
        • help define extent of infection
  • Treatment
    • Operative
      • incision and drainage in conjunction with IV antibiotics
        • indications
          • standard of care for deep space infections and collar button abscesses
        • technique
          • use volar and dorsal incisions for collar button abscesses
          • avoid skin in actual web space
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