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Deep Space of Hand Bursa

bursa spatii profundi manus

The deep spaces of the hand are potential bursal spaces between the flexor tendons and the interosseous and adductor muscles. The thenar space lies radial to the midpalmar septum and the adductor pollicis; the midpalmar space lies between the flexor tendons and the metacarpals ulnar to the midpalmar septum. These potential spaces are not true bursae at rest but expand in deep palmar space infections.

Region: Hand & Wrist

Clinical Relevance

Clinical Notes

Deep palmar space infections (thenar space abscess and midpalmar space abscess) are serious hand infections that spread from neglected flexor tenosynovitis or penetrating trauma, producing a palpable fullness obliterating the normal palmar concavity, severe pain with any finger movement, and systemic sepsis. They require urgent surgical drainage through specific approaches: the thenar space via a dorsal first web space incision, and the midpalmar space via a transverse palmar incision. Anatomic knowledge of the midpalmar and thenar septum is essential to avoid inadvertent spread between compartments.

Pathology

Common Injuries & Conditions

Deep Palmar Space Abscess

Bacterial infection in the thenar or midpalmar potential space from penetrating trauma or secondary spread from flexor tenosynovitis produces a tense palm with loss of the normal concavity, intense pain on finger movement, and sepsis requiring urgent incision and drainage under tourniquet through space-specific surgical approaches.