The superficial pulp space of the fingers

The tips of the fingers and thumb are composed entirely of subcutaneous fat broken up and packed between fibrous septa, which pass from the skin down to the periosteum of the terminal phalanx. The tight packing of this compartment is responsible for the severe pain of a 'septic finger'—there is little room for the expansion of inflamed and oedematous tissues.

The blood vessels to the shaft of the distal phalanx must traverse this space and may become thrombosed in a severe pulp infection with resulting necrosis of the diaphysis of the bone. The base of the distal phalanx receives its blood supply more proximally from a branch of the digital

Branch to base of distal phalanx

Digital artery

Superficial Pulp Space Finger

Distal pulp space

Branches to shaft of distal phalanx traversing the pulp space

Fig. 145 The distal pulp space of the finger—note the distribution of the arterial supply to the distal phalanx.

Distal pulp space

Branch to base of distal phalanx

Digital artery

Branches to shaft of distal phalanx traversing the pulp space

Fig. 145 The distal pulp space of the finger—note the distribution of the arterial supply to the distal phalanx.

artery in the middle segment of the finger and therefore survives. At each of the skin creases of the fingers, the skin is bound down to the underlying flexor sheath so that the pulp over each phalanx is in a separate compartment cut off from its neighbours. Infection may, however, track from one space to another along the neurovascular digital bundles.

Over the palm of the hand there is very little subcutaneous tissue, the skin adhering to the underlying palmar aponeurosis; in contrast, the skin of the dorsum of the fingers and hand is loose and fluid can, therefore, readily collect beneath it. Unless this is remembered, the marked dorsal oedema which may accompany sepsis of the palmar aspect of the fingers or hand may result in the primary site of the infection being overlooked.

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Responses

  • veli
    What is name of clinical disease of pulp space of finger ?
    2 years ago

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