Hand compartments5/26/2023 ![]() ![]() The anatomy of the compartments in the forearm and hand as well as in the lower leg and foot are described. The extremities are susceptible to compartment syndrome if the balance between inflow and outflow in the compartments is disturbed, i.e., the relation between hydrostatic pressure and interstitial fluid pressure. Thorough inspection within anatomic areas or generous release of the muscular origin along the metacarpal at the time of fasciotomy is suggested to ensure complete inspection. Subcompartmentalization of the enclosed myofascial spaces of the hand should be anticipated in cases requiring fasciotomy. The dorsal and palmar interosseous muscles were discrete compartments within the second interosseous compartment in 48% of the hands, within the third interosseous compartment in 67%, and within the fourth interosseous compartment in 33%. The interosseous compartments demonstrated significant variability. The adductor pollicis and first dorsal interosseous muscles were discrete compartments in 71% of the hands. ![]() In 76% of the specimens, the hypothenar space demonstrated at least 2 compartments. The results showed the thenar space to comprise 2 or more discrete compartments in 52% of the hands. Data were collected from the prepared cross-sections of each specimen. Because of the attachment of the muscles and the location of the hood, the small intrinsic muscles will produce flexion at the metacarpophalangeal joint while extending the interphalangeal joints.To determine the nature and number of enclosed myofascial spaces in the hand, an anatomic study that included 21 cadaver hands was conducted using a gelatin injection method. The small intrinsic muscles that attach laterally are responsible for delicate finger movements that would not be possible with the extensor digitorum, flexor digitorum superficialis, and profundus muscles alone. Laterally, the lumbricals and the dorsal and palmar interossei muscles attach. Proximally and centrally, the extensor digitorum, extensor digiti minimi, extensor indicis, and extensor pollicis brevis muscles attach to the dorsal digital expansion. An aponeurosis covering the dorsum of the digits and attaches distal to the distal phalanx. The extensor retinaculum works to retain the tendons that are near the bone while allowing proximal and distal gliding of the tendons ( Figure 33-1B). Continuous with the fascia of the forearm and attached laterally to the radius and medially to the triquetrum and pisiform bones. This ligament should not be confused with the flexor retinaculum, which is located deeper to the transverse palmar ligament. ![]() Continuous with the extensor retinaculum from the dorsal side of the wrist and wraps around, anteriorly, to form a fascial band around the flexor tendons. Laterally, the flexor retinaculum is anchored to the scaphoid and trapezium. ![]() The flexor retinaculum anchors medially to the pisiform and the hook of the hamate. The median nerve and the tendons of the flexor digitorum superficialis, flexor digitorum profundus, and flexor pollicis longus muscles, and their associated synovial sheaths, pass through this tunnel. Forms a roof over the concavity created by the carpal bones, forming a tunnel (i.e., the carpal tunnel). Flexor retinaculum (transverse carpal ligament).Form a tunnel that encloses the flexor tendons of digits 2 to 5 and the tendon of the flexor pollicis longus muscle and their associated synovial sheaths. The palmar aponeurosis extends distally and becomes continuous with the fibrous digital sheaths. Located over the palm of the hand and covers the flexor tendons and deeper structures of the hand. ![]()
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