Modern surgery, general and operative . tions of the skin of thepalm. A thecal abscess in a flexor tendonof a finger travels rapidly upward and may produce a palmar abscess. A thecal abscess of either the index, ring, or middlefinger is usually arrested at the lower end of the palm, but suppurative thecitisof the thumb or the little finger conducts pus along the tendon sheath and up thearm (Fig. 451). If the theca ruptures, pus is diffused over the palm. Abscessproduces great swelling of the hand and fingers, the dorsum being swollen asw^ell as the palm. The fingers become flexed and rigid. Vi
Modern surgery, general and operative . tions of the skin of thepalm. A thecal abscess in a flexor tendonof a finger travels rapidly upward and may produce a palmar abscess. A thecal abscess of either the index, ring, or middlefinger is usually arrested at the lower end of the palm, but suppurative thecitisof the thumb or the little finger conducts pus along the tendon sheath and up thearm (Fig. 451). If the theca ruptures, pus is diffused over the palm. Abscessproduces great swelling of the hand and fingers, the dorsum being swollen asw^ell as the palm. The fingers become flexed and rigid. Violent pulsatile painand decided constitutional disturbance exist. Discoloration is late in appear-ing. Related lymph-glands enlarge. Palmar abscess is a most serious affec-tion. The pus may dissect up all the structures of the palm, may pass betweenthe bones and reach the dorsum, or may pass beneath the anterior annularligament into the connective-tissue planes of the forearm. In some cases itleaves a clawed, stiff, and useless Fig. 451.—Palmar synovial sheaths(vaginas tendinum), normal adult type(Poirier and Charpy). 722 Diseases and Injuries of Muscles, Tendons, and Bursae Treatment.—A palmar abscess demands radical treatment at the earliestpossible moment; delay will be responsible for stiiJ and contracted fingers andhyperesthetic skin, a damaged and perhaps a useless hand. The placed under the influence of ether. The incision is made in theline of the metacarpal bone and, if possible, below the palmar arches. Aline transverse with the web of the thumb is below the palmar arches. In anincision above this line try not to cut either arch; but if one should be cut, atonce take means to arrest the hemorrhage (see page 449). In a severe case itmay be necessary to make several palmar incisions, to open the tendon-sheathson the flexor surface of the forearm above the wrist, and to make counter-openings in the back of the hand, and it is sometimes neces
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