Infection of the midpalmar space is a rare, closed-space infection that may be difficult to diagnose. It is either a primary infection caused by direct bacterial inoculation or a secondary infection spread through adjacent areas. Flexor tendon sheath infections involving the long and ring fingers can spread into the midpalmar space. Aggressive treatment that includes intravenous (IV) antibiotics, drainage, debridement and intraoperative irrigation is necessary to control and prevent further spreading of the infection.1,2
Incidence and Related Conditions
Reproduced from the International statistical classification of diseases and related health problems, 10th revision, Fifth edition, 2016. Geneva, World Health Organization, 2016 https://apps.who.int/iris/handle/10665/246208
This is an extremely rare diagnosis, but infection in the midpalmar space is most considered whenever the patient presents with signs of infection and severe palmar swelling and tenderness. The typical patient is likely to have either a long or ring finger flexor tendon sheath infection which has spread to the midpalmar space. In the antibiotic era, patients with midpalmar space infections are likely to either have a neglected finger infection, have diabetes, is immunocompromised and/or is a drug user.
Once the incision and drainage is done, these patient will likely need dressing changes, whirlpool treatments and aggressive hand therapy to preserve and regain hand function.