Marcus Z X Ling1, V P Kumar. 1. Singapore From the Department of Orthopaedic Surgery, National University Hospital, and the Department of Orthopaedic Surgery, Yong Loo Lin School of Medicine, National University of Singapore.
Abstract
BACKGROUND: Acute compartment syndrome of the hand is an emergency requiring prompt surgical decompression. This cadaveric study aims to identify the myofascial compartments of the hand by detailed dissection and direct visualization, to provide an accurate anatomical basis for surgical decompression. METHODS: Fourteen fresh-frozen cadaveric hands were dissected. The findings were recorded by still digital photography. RESULTS: 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. CONCLUSIONS: This study has shown that no distinct tough fascia surrounded any of the intrinsic muscles of the hand completely. The thin filmy fascia partially encasing some of the muscles is unlikely to contribute to development of compartment syndrome. It is postulated that the unyielding overlying skin may serve as a constricting layer in addition to the fascia and contribute to raised intracompartmental pressures.
BACKGROUND: Acute compartment syndrome of the hand is an emergency requiring prompt surgical decompression. This cadaveric study aims to identify the myofascial compartments of the hand by detailed dissection and direct visualization, to provide an accurate anatomical basis for surgical decompression. METHODS: Fourteen fresh-frozen cadaveric hands were dissected. The findings were recorded by still digital photography. RESULTS: 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. CONCLUSIONS: This study has shown that no distinct tough fascia surrounded any of the intrinsic muscles of the hand completely. The thin filmy fascia partially encasing some of the muscles is unlikely to contribute to development of compartment syndrome. It is postulated that the unyielding overlying skin may serve as a constricting layer in addition to the fascia and contribute to raised intracompartmental pressures.