Blood Supply to Hand

Author: Derek Moore

Topic updated on 05/12/13 4:51pm

Source Arteries

Radial artery
- runs between brachioradialis and flexor carpi radialis
Ulnar artery
- runs under flexor carpi ulnaris
- lateral to ulnar nerve at the wrist
- enters the hand through Guyon's canal
Supplemental arteries
- anterior interosseous artery
- posterior interosseous artery
- median artery (occasionally)

Superficial Arch

Location
- directly deep to palmar fascia
- distal to the to the deep arch
- surface marked by Kaplan's cardinal line
  - line drawn across the palm parallel to the distal edge of the fully abducted thumb
Blood supply
- predominant supply is ulnar artery
- minor supply from superficial branch of radial artery
Relations
Branches of superficial arch
- 1st branch
  - is the deep branch that provides the minor supply to the deep palmar arch
- 2nd branch
  - is the ulnar palmar digital artery of the little finger
- 3rd, 4th, 5th, and 6th branches
  - are the common palmar digital arteries
  - in the palm, the digital arteries are volar to the digital nerves
  - in the digits, the digital artery is dorsal to digital nerve
    - in the digits, the neurovascular bundle is volar to Cleland's ligament
- multiple branches to intrinsic muscles and skin
The proper digital artery to the ulnar side of the little finger arises directly from the superficial arch

Deep Arch

Location
- deep to the flexor tendons (FDS, FDP)
- proximal to the superficial arch
- at the level of the base of the metacarpals
Blood supply
- predominant supply is the deep branch of the radial artery
- minor supply from the deep branch of the ulnar artery
Deep branch of radial artery passes between 2 heads of 1st dorsal interosseous and then splits into
- deep arch
  - branches into the 3 common digital arteries in the 2nd, 3rd, and 4th web spaces.
- princeps pollicis artery
  - gives a branch to the radial side of the index finger and then bifurcates into the digital arteries of the thumb
The proper digital artery to the radial side of the index finger arises directly from the deep arch

Anatomical Landmarks
Arch	Kaplan's cardinal line	Distal wrist crease	Image
Superficial	15mm distal	5cm distal
Deep	6mm distal	4cm distal

Digital Arteries

Common digital arteries arise from the superficial palmar arch
Divide into proper digital arteries at the web spaces
Gives dorsal branches distal to the PIP joints

Dorsal Arteries

Origin
- posterior interosseous artery
- dorsal perforating branch of anterior interosseous artery
Form a dorsal carpal arch which give rise to dorsal metacarpal arteries
- useful for dorsal metacarpal artery flaps
- 1st and 2nd dorsal metacarpal artery are more consistent than 3rd and 4th

Veins

Deep veins
- veins follow the deep arterial system as venae comitantes
Superficial veins
- found at the hand dorsum
- contribute to the basilic and cephalic vein system

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TAG

(OBQ07.33) In the majority of patients, the deep palmar arch has a main contribution from what vessel which travels between the two heads of the first dorsal interosseous muscle? Topic

Review Topic

1. Superficial palmar branch of the radial artery
2. Princeps pollicis artery
3. Deep dorsal (terminal) branch of the radial artery
4. Common palmar digital artery
5. Ulnar artery

PREFERRED RESPONSE ▶

DISCUSSION: The deep palmar arch (deep volar arch) is an arterial network found in the palm. In the majority of patients it is formed mainly from the terminal part of the radial artery, with the ulnar artery contributing via its deep palmar branch. This is in contrast to the superficial palmar arch, which is formed predominantly by the ulnar artery with some contribution by the superficial palmar branch of the radial artery. The deep palmar arch lies upon the bases of the metacarpal bones and on the interossei of the hand, being covered by the oblique head of the adductor pollicis muscle, the flexor tendons of the fingers, and the lumbricals of the hand. At the wrist the radial artery passes between the radial collateral ligament and the first dorsal compartment after which it dives between the heads of the first dorsal interossei where it anastomoses with the deep palmar branch from the ulnar artery, completing the deep volar arch.

Illustrations: A

REFERENCES:

1. Hollingshead WH: Anatomy for Surgeons, 3rd Ed. Philadelphia, PA, Harper and Row, 1982.

2. Anderson JE: Grant's Atlas of Anatomy. 8th Ed. Baltimore: Williams & Wilkins, 1983.

Question Authors:

Robert Boykin MD,

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(OBQ04.86) Which of following most appropriately details the anatomic orientation of the digital nerve and artery in the finger? Topic

Review Topic

1. Artery palmar and radial to nerve
2. Nerve dorsal and ulnar to artery
3. Nerve medial to artery
4. Artery ulnar to nerve
5. Artery dorsal to nerve

PREFERRED RESPONSE ▶

DISCUSSION: The digital nerve is palmar to the artery in the finger. A helpful way of remembering this orientation is that sensation is performed with the pads (nerve is palmar) of your fingers and you test for cap refill at the fingernail (artery is dorsal).

Illustration A shows a cross section of the finger and the relative position of the artery and the nerve.

Illustrations: A

REFERENCES:

1. Upper Limb: Anterior aspect of wrist & hand, in Agar AM, Lee MJ (eds): Grant’s Atlas of Anatomy, ed 10. Philadelphia, PA, Lippincott Williams & Wilkins, 1999, pp 480-505

2. Agur AM, Lee MJ: Grant’s Atlas of Anatomy. Philadelphia, PA, Lippincott Williams & Wilkins, 1999

Question Authors:

Michael Hughes MD, John Badylak MD, Derek Moore, Bobby Chhabra M.D.,

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Groups

ABOS II: Blood Supply to Hand

General - Oral Boards Review

7/29/2011

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Evidence & References Show References

Textbooks

Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Hollingshead WH: Anatomy for Surgeons, 3rd Ed. Philadelphia, PA, Harper and Row, 1982.
Anderson JE: Grant's Atlas of Anatomy. 8th Ed. Baltimore: Williams & Wilkins, 1983.
Upper Limb: Anterior aspect of wrist & hand, in Agar AM, Lee MJ (eds): Grant’s Atlas of Anatomy, ed 10. Philadelphia, PA, Lippincott Williams & Wilkins, 1999, pp 480-505
Agur AM, Lee MJ: Grant’s Atlas of Anatomy. Philadelphia, PA, Lippincott Williams & Wilkins, 1999

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Blood Supply to Hand

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