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200
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Anatomy

Upper Limb

Question 227 of 239

A 32 year old farm worker has presented to the ED with an infected laceration on a finger. You are concerned about the possible spread of infection into the midpalmar space. Infections in the digital synovial sheath of which fingers are most likely to spread to the midpalmar space:

Answer:

Infections may occur in the digital synovial sheath for example after a puncture wound of a finger. Infection in the middle three digits is usually contained as they have separate synovial sheaths.

Flexor Sheath Infection

Anatomy / Upper Limb / Wrist and Hand

Last Updated: 12th August 2019

Infections may occur in the digital synovial sheath for example after a puncture wound to a finger.

Infection in the middle three fingers is usually contained as they have separate synovial sheaths.

The synovial sheath of the little finger is usually continuous with the common flexor sheath (the ulnar bursa) and thus infection may spread to this sheath and from here to the midpalmar space.

Infections in the thumb may spread to the midpalmar space via the continuous synovial sheath of the flexor pollicis longus (the radial bursa).

By Henry Vandyke Carter [Public domain], via Wikimedia Commons

Flexor Sheaths. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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