Other

Radial & Ulnar Bursal Infections

 

Bursal Anatomy

 

Enclose flexor tendons

 

Ulnar bursa is extension of little finger synovial sheath

 

Radial is extension of thumb synovial sheath

 

Coalesce in carpal tunnel to envelope all flexors

- 50% of time radial and ulna bursa communicate

- can get horse shoe collections

 

Deep Space Infections

 

Clinical

 

Palmar pain and swelling

 

Dorsal pain and swelling

 

Anatomy

 

Midpalmar septum

- to MF Metacarpal

 

Hypothenar septum

- to LF Metacarpal

 

Potential Spaces

- thenar space

- midpalmar space

 

Thenar space

- ulnarly by midpalmar septum

- dorsally by Adductor Pollicis

- palmarly by index finger flexor tendon

 

Drainage

- dorsal incision (can spread to involve 1st dorsal interossei)

- palmar incision

 

Midpalmar Space 

- Radial border midpalmar septum

- Ulnar hypothenar septum

- Dorsally 3-5 metacarpals

- palmar flexor tendons and lumbricals

 

Management

- transverse incision across palm

 

Web Space Infection

 

Boundaries

- dorsally web skin

- Volar by transverse palmar fascia

- Radially and Ulnarly by fibrous septa

 

Management

- both dorsal and volar incisions to ensure adequate drainage

- Avoid transverse incisions --> Contracture

 

Herpetic Whitlow

 

Aetiology

 

Cut on finger

- exposed to oral secretions

 

Symptoms

 

Often extremely painful

 

Management

 

Oral antivirals

Recurrence 30 - 50%

 

Atypical Mycobacterium

 

Aetiology

 

Mycobacterium marinum

- aquatic trauma

 

Clinical

 

Abundant tenosynovitis or joint synovitis

 

May take 8 weeks to culture on LJ medium

 

Management

 

Debridement

3-6 months ABx