Palmar space infections occur within the deep fascial spaces, commonly from puncture wounds or hematogenous spread. The palm loses its concavity; tenderness, erythema, warmth, and fluctuance are evident. A thenar space infection is characterized by swelling over the thenar eminence and pain with thumb movement. With a midpalmar space infection, motion is limited and painful for the middle and ring fingers. Cellulitis, local traumatic injury, fractures, and soft-tissue mass are included in the differential.
Management and Disposition
All deep space infections of the hand should be managed by a hand surgeon. Prompt incision and drainage in the operating room is necessary for the best outcome. Parenteral antibiotics against S aureus (including CA-MRSA) as well as anaerobes should be started urgently.
Palmar space infections may cause swelling on the dorsal hand due to the dorsal location of hand lymphatics.
There may be minimal signs of swelling over the palmar surface.
Infections may be associated with compartment syndrome of the hand.
Thenar Space Infection. Thenar space infection following injury to the thumb. In this palmar view, erythema and swelling in the right thenar area are evident. (Photo contributor: Richard Zienowicz, MD.)