Monday, February 16, 2009

Myofascial Compartments of the Hand in Relation to Compartment Syndrome --- an Article Review

Updated 3/2017-- photos and all links (except to my own posts) removed as many no longer active. and it was easier than checking each one. 

Acute compartment syndrome of the hand is an emergency and  requires prompt surgical decompression.  This article (the first reference below) is a cadaveric study aimed at identifying the myofascial compartments of the hand.  As they point out
Few studies have outlined the myofascial compartments of the hand. The standard anatomy texts do not show actual anatomical specimens but instead rely on diagrams and figures to outline the various compartments. These include the thenar, hypothenar, adductor, and interosseous compartments, each encased in fascia that extended from one metacarpal to another

The ten anatomical compartments of the hand include (photo credit)
  • four dorsal interossei
  • three palmer interossei
  • adductor pollicis
  • thenar
  • hypothenar

The authors dissected fourteen fresh-frozen cadaveric hands.  They found no distinct tough fascia completely surrounding any of the intrinsic muscles, but instead thin filmy fascia that partially encases some of the muscles. 
There was no well-defined tough fascia overlying the thenar muscles, the hypothenar muscles, or the adductor pollicis.
Areolar tissue was present between the individual thenar and hypothenar muscles.
A distinct band of fascia was noted over the entire length of the ulnar three dorsal interosseous muscles.
A band of fascia was noted over the distal portion of the palmar interossei but not over the proximal aspect.
The above findings were found in all 14 specimens.
A layer of loose areolar tissue was noted over the dorsal aspect of the first web space in eight specimens, whereas a distinct band of fascia was noted overlying the first dorsal interosseous muscle in the remaining six.
Interesting findings, but doesn’t explain why it is necessary to do the fasciotomies in each and every compartment.  Does the skin constrict that much?  Maybe.

Myofascial Compartments of the Hand in Relation to Compartment Syndrome: A Cadaveric Study; Plastic and Reconstructive Surgery:Volume 123(2)February 2009, pp 613-616; Ling, Marcus Z. X. M.B.B.S.; Kumar, V P. F.R.C.S.
Beware: Compartment Syndrome of the Hand; JNZMA, Feb 11, 2005, Vol 118, No 1209; Warren Leigh, Vasu Pai
Compartment Syndromes of Hand and Forearm; Wheeless' Textbook of Orthopaedics; Last updated by Clifford R. Wheeless, III, MD on Sunday, December 28, 2008 8:31 pm
Compartment Syndrome, Upper Extremity; eMedicine Article, July 27, 2007; Stephen Wallace, MD and Douglas G Smith, MD

No comments: