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