Updated: 5/28/2018

Deep Space & Collar Button Infections

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https://upload.orthobullets.com/topic/6106/images/deep hand 2.jpg
https://upload.orthobullets.com/topic/6106/images/thenar space.jpg
https://upload.orthobullets.com/topic/6106/images/deep spaces.jpg
https://upload.orthobullets.com/topic/6106/images/midpalmar.jpg
https://upload.orthobullets.com/topic/6106/images/hypothenar.jpg
https://upload.orthobullets.com/topic/6106/images/deep 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 small, 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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