Palmar Aponeurosis
By : Rashad Omar
Firstly , what the aponeurosis means?
The aponeurosis is a thickened deep fascia that protects the underlying muscles and other deep structures
The aponeurosis is a thickened deep fascia that protects the underlying muscles and other deep structures
Definition
it’s a triangular thickened deep fascia that protects the palm of hand .
Its apex is directed proximally and the base distally , th apex is continuous with flexor retinaculum and receives the insertion of palmaris longus tendon.
Its base is divided into four slips to medial 4 finger each slip divides into two bands , one attaches to skin of palm and the deep one is divided into two , which diverge around the flexor tendon and fuse with the fibrous flexor sheath at the roots of fingers, its borders send fibrous septa to palm share in the formation of fascial spaces of palm.
Its base is divided into four slips to medial 4 finger each slip divides into two bands , one attaches to skin of palm and the deep one is divided into two , which diverge around the flexor tendon and fuse with the fibrous flexor sheath at the roots of fingers, its borders send fibrous septa to palm share in the formation of fascial spaces of palm.
Palmar aponeurosis
the palmar aponeurosis also gives origin to palmaris brevis muscle .
Palmaris brevis m.
It sends medial & lateral septa to 5th &1st metacarpal bones respectively , the lateral border of palmar aponeurosis sends another septum passes obliquely to the 3rd metacarpal bone (intermediate palmar septum ), these septa divide the palm into :
1 - medial compartment ( medial to medial septum ) containing the hypothenar muscles &bounded anteriorly by the hypothenar fascia
2 - lateral compartment ( lateral to lateral septum ) containing the thenar muscles & and bounded anteriorly by the thenar fascia
3 - intermediate compartment ( between the two )
Which is divided by the intermediate palmar septum into :
Midpalmar space
Thenar space ( which must be separated from the lateral compartment which contains the thenar muscles by lateral palmar septum )
1 - medial compartment ( medial to medial septum ) containing the hypothenar muscles &bounded anteriorly by the hypothenar fascia
2 - lateral compartment ( lateral to lateral septum ) containing the thenar muscles & and bounded anteriorly by the thenar fascia
3 - intermediate compartment ( between the two )
Which is divided by the intermediate palmar septum into :
Midpalmar space
Thenar space ( which must be separated from the lateral compartment which contains the thenar muscles by lateral palmar septum )
Facsial spaces of hand
(A) medial compartment (B) intermediate compartment ( 1-thenar space , 2- midpalmar space ) (c) lateral compartment
The structures deep to palmar aponeurosis
1 _ Superficial & deep palmar arches.
2 _ Tendons of flexor digitorum superficialis & flexor digitorum profundus.
3 _ Lumbrical muscles
4 _ Deep branch of ulnar n.
5 _ Digital branches of median n.
6 _ Common palmar digital branches
2 _ Tendons of flexor digitorum superficialis & flexor digitorum profundus.
3 _ Lumbrical muscles
4 _ Deep branch of ulnar n.
5 _ Digital branches of median n.
6 _ Common palmar digital branches
The structures deep to palmar aponeurosis
Clinical notes
Dupuytren's Contracture :
Also called ( dupuytren’s disease )It’s an abnormal thickening in the palmar aponeurosis at the root of fingers that lead to formation of nodules and to contracture of one or more of the fingers with time , it mainly occurs in ring & little finger and more common in male than female ( usually in people above the age of 50 ) , sometimes it occurs in both hands and rarely affects feet.
Also called ( dupuytren’s disease )It’s an abnormal thickening in the palmar aponeurosis at the root of fingers that lead to formation of nodules and to contracture of one or more of the fingers with time , it mainly occurs in ring & little finger and more common in male than female ( usually in people above the age of 50 ) , sometimes it occurs in both hands and rarely affects feet.
Dupuytren's Contracture
The causes of this disorder may be genetic causes so it commonly occurs in families .
smoking , diabetes and alcoholism are also involved in the causes of this disease , it also common in people who take medicine for seizures
smoking , diabetes and alcoholism are also involved in the causes of this disease , it also common in people who take medicine for seizures
The Treatment :
the treatment depends on the severity of the disease , as well as the age of patient .
There is no cure for this disorder but there are techniques to keep the condition from becoming worse and slow the disease , the treatment Focuses on restoring your hand movement , these techniques include :
surgery ( in serious cases ) in which the surgeon removes thickened tissue
radiation therapy (in early conditions )
steroid injection ( to reduce the pain )
enzyme injection & needle aponeurotomy.
the treatment depends on the severity of the disease , as well as the age of patient .
There is no cure for this disorder but there are techniques to keep the condition from becoming worse and slow the disease , the treatment Focuses on restoring your hand movement , these techniques include :
surgery ( in serious cases ) in which the surgeon removes thickened tissue
radiation therapy (in early conditions )
steroid injection ( to reduce the pain )
enzyme injection & needle aponeurotomy.
Over time the condition may improve and you’ll not be able to use your hand as usual ( you can’t grasp large things or extend your fingers), so You should visit a specialist to develop an appropriate treatment plan for you .
Reference
1 _ LAWRENCE E. WINESKI Snell's Clinical Anatomy by Regions /10th edition (2018 ) p.122, 123
2 _ Moore - Clinically Oriented Anatomy 7th Edition , p.773
3 _ Dupuytren's Contracture , John Hoskins Medicine , https://www.hopkinsmedicine.org/health/conditions-and-diseases/dupuytrens-contracture?amp=true
2 _ Moore - Clinically Oriented Anatomy 7th Edition , p.773
3 _ Dupuytren's Contracture , John Hoskins Medicine , https://www.hopkinsmedicine.org/health/conditions-and-diseases/dupuytrens-contracture?amp=true
Reference of images
1 _ cover image : palmar aponeurosis , Outlander Anatomy , https://images.app.goo.gl/97k1QgufLAJXDJQw9
2 _ figure 1 : palmar aponeurosis , Fife Virtual Hand Clinic , https://images.app.goo.gl/LgKubc2w87TPbRU28
3 _ figure 2 : Palmaris brevis , kenhub, https://images.app.goo.gl/Zhsg2E9gZrvHBcCM8
4 _ figure 3 : Fascial spaces of hand , OG-Anatomy , https://www.google.com/imgres?imgurl=http%3A%2F%2Fwww.oganatomy.org%2Fatlas%2Fhandcompartments.jpg&imgrefurl=http%3A%2F%2Fwww.oganatomy.org%2Fprojanat%2Fgross%2F18%2Fthree.htm&tbnid=AGoBKtv3T_WUQM&vet=1&docid=ClegZsMeRckt5M&w=350&h=308&hl=ar-iq&source=sh%2Fx%2Fim
5 _ figure 4 : Netter Atlas of Human Anatomy / plate 447
6 _ figure 5 : Dupuytren's disease , Author : jack Wang MD. , Buoy health , https://www.google.com/imgres?imgurl=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0b678gck%2Fbuoy-public-site%2F453872ef7f5f33ee1de0af347767faf7c510dc09-1500x1500.jpg&imgrefurl=https%3A%2F%2Fwww.buoyhealth.com%2Flearn%2Fdupuytrens-disease&tbnid=CoyDbf1uGuRvaM&vet=1&docid=QAafg17Na73r9M&w=1500&h=1500&hl=ar&source=sh%2Fx%2Fim
2 _ figure 1 : palmar aponeurosis , Fife Virtual Hand Clinic , https://images.app.goo.gl/LgKubc2w87TPbRU28
3 _ figure 2 : Palmaris brevis , kenhub, https://images.app.goo.gl/Zhsg2E9gZrvHBcCM8
4 _ figure 3 : Fascial spaces of hand , OG-Anatomy , https://www.google.com/imgres?imgurl=http%3A%2F%2Fwww.oganatomy.org%2Fatlas%2Fhandcompartments.jpg&imgrefurl=http%3A%2F%2Fwww.oganatomy.org%2Fprojanat%2Fgross%2F18%2Fthree.htm&tbnid=AGoBKtv3T_WUQM&vet=1&docid=ClegZsMeRckt5M&w=350&h=308&hl=ar-iq&source=sh%2Fx%2Fim
5 _ figure 4 : Netter Atlas of Human Anatomy / plate 447
6 _ figure 5 : Dupuytren's disease , Author : jack Wang MD. , Buoy health , https://www.google.com/imgres?imgurl=https%3A%2F%2Fcdn.sanity.io%2Fimages%2F0b678gck%2Fbuoy-public-site%2F453872ef7f5f33ee1de0af347767faf7c510dc09-1500x1500.jpg&imgrefurl=https%3A%2F%2Fwww.buoyhealth.com%2Flearn%2Fdupuytrens-disease&tbnid=CoyDbf1uGuRvaM&vet=1&docid=QAafg17Na73r9M&w=1500&h=1500&hl=ar&source=sh%2Fx%2Fim
