An MRI pictorial study of the deep fascial spaces of the palm and wrist. Crockett MT, Mitchell D, Aherne E, Kavanagh EC Department of Radiology, Mater Misericordiae University Hospital, Dublin 7. An MRI pictorial study of the deep fascial spaces of the palm and wrist. Crockett MT, Mitchell D, Aherne E, Kavanagh EC Department of Radiology, Mater Misericordiae University Hospital, Dublin 7. Background and aim: Infections of the deep fascial spaces of the hand and wrist are well recognised. Early diagnosis is essential in order to prevent potentially devastating complications secondary to damage to adjacent tendons, nerve sheaths bones and joints. Potential sites for infection include the radial or ulnar bursae, Parona’s space, thenar space, midpalmar space, and hypothenar space. The midpalmar and thenar spaces communicate with the space of Parona through the carpal tunnel and are contiguous with the radial and ulnar bursae. Infections of the radial or ulnar bursae can spread to the space of Parona, and an infected wrist joint can also rupture into the space. A detailed knowledge of the anatomy of these deep fascial spaces is essential to allow early diagnosis with MRI the imaging modality of choice. In spite of this there is a paucity of literature accurately delineating the MRI anatomy of these spaces. The aim of this pictorial study is to define and describe the normal anatomy of the deep fascial spaces of the hand and wrist using 3Telsa MRI and MR arthrography. Coronal MRI defining the borders of the midpalmar space (red outline), thenar space (green outline) and space of Parona (blue outline). The midpalmar space and thenar space communicate with the space of Parona via the carpal tunnel. Axial MRI at level of distal carpal tunnel defining the borders of the central compartment of the hand (open red arrow) and the midpalmar space (closed red arrow). Axial MRI at the level of the distal forearm defining the border of the space of Parona (open red arrow). Saggital and axial MR arthrogram at level of distal forearm demonstrating contrast within the space of Parona (open white arrow). The dorsal and volar borders of the space of Parona are formed by the pronator quadratus (blue arrow) and flexor tendons within their sheaths (green arrow) respectively. Axial MRI at level of the mid palm defining the boundaries of the thenar compartment of the hand (open red arrow), thenar space (closed red arrow, red shading), central compartment of the hand (open white arrow), midpalmar space (closed white arrow, white shading) and hypothenar compartment of the hand (open green arrow). Axial MRI at level of distal palm defining the boundaries of the central compartment of the hand (open white arrow) and the midpalmar space (closed white arrow, white shading). Diagram delineating the deep fascial compartments of the hand and their borders (axial section at level of mid palm). Diagram delineating the space of Parona and its borders (closed red arrow) in the distal forearm. The space lies between the belly of the pronator quadratus (blue arrow) and the flexor tendons of the hand (green arrow).

Mater Hospital DCU Irish Cancer Society Conclusion: