Updated: 5/23/2021

Blood Supply to Hand

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Flashcards
3
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Questions
2
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Evidence
1
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Cases
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Topic
Images
https://upload.orthobullets.com/topic/6007/images/arches.jpg
https://upload.orthobullets.com/topic/6007/images/superficial arch close.jpg
https://upload.orthobullets.com/topic/6007/images/digital artery and nerve.jpg
https://upload.orthobullets.com/topic/6007/images/deep arch close.jpg
  • Source Arteries
    • Radial artery
      • runs between brachioradialis and FCR
      • enters the dorsum of the carpus by passing between FCR and APL/EPB tendons (in the snuffbox)
      • gives off superficial palmar branch (communicates with superficial arch)
      • finally passes between 2 heads of 1st dorsal interosseous to form the deep palmar arch
    • Ulnar artery
      • runs under flexor carpi ulnaris
      • lateral to ulnar nerve at the wrist
      • enters the hand through Guyon's canal
      • lies on the transverse carpal ligament
    • Supplemental arteries
      • anterior interosseous artery
      • posterior interosseous artery
      • median artery (occasionally)
  • Superficial Arch
    • Anatomy
      • deep to palmar fascia
      • distal to the deep arch
      • surface marking
        • at the level of a 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
    • Branches of superficial arch (from ulnar to radial)
      • 1st branch
        • is the deep branch that provides the minor supply to the deep palmar arch
      • 2nd branch
        • is the ulnar digital artery of the little finger
          • the proper digital artery to the ulnar side of the little finger arises directly from the superficial arch
      • 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 arteries are dorsal to the digital nerves
          • in the digits, the neurovascular bundle is volar to Cleland's ligament
      • multiple branches to intrinsic muscles and skin
    • The superficial arch is complete (branches to all digits) in 80% of individuals
  • Deep Arch
    • Anatomy
      • deep to the flexor tendons (FDS, FDP)
      • proximal to the superficial arch
      • at the level of the base of the metacarpals
      • surface marking
        • 1 fingerbreadth proximal to a line drawn across the palm parallel to the distal edge of the fully abducted thumb
        • 1 fingerbreadth proximal to the superficial arch
    • Blood supply
      • predominant supply is the deep branch of the radial artery
      • minor supply from the deep branch of the ulnar artery
    • Branches of the deep arch (from radial to ulnar)
      • princeps pollicis
        • runs between 1st dorsal interosseus and adductor pollicis
      • branch to the radial side of the index finger
        • the proper digital artery to the radial side of the IF arises directly from the deep arch
      • branches to the 3 common digital arteries in the 2nd, 3rd, and 4th web spaces
    • The deep arch is complete (branches to all digits) in 97% of individuals
    • Anatomic landmarks of the arches
      Arch
      Karplan's Cardinal line
      Distal Wrist Crease
      Superficial
      15mm distal
      50mm distal
      Deep
      7mm distal
      40mm 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
    • Dominant arteries are found on the median side of the digit (closer to midline)
      • in the index finger, the ulnar digital artery is dominant
      • in the little finger, the radial digital artery is dominant
        • in the middle and ring fingers, ulnar and radial digital arteries are dominant respectively, but dominance is less obvious
  • Dorsal Arteries
    • Blood supply
      • posterior interosseous artery
      • dorsal perforating branch of anterior interosseous artery
    • Form a dorsal carpal arch which gives 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
Flashcards (3)
Cards
1 of 3
Questions (2)

(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?

QID: 694
1

Superficial palmar branch of the radial artery

7%

(254/3525)

2

Princeps pollicis artery

9%

(301/3525)

3

Deep dorsal (terminal) branch of the radial artery

74%

(2613/3525)

4

Common palmar digital artery

1%

(52/3525)

5

Ulnar artery

8%

(285/3525)

L 2 D

Select Answer to see Preferred Response

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

QID: 1191
1

Artery palmar and radial to nerve

7%

(249/3699)

2

Nerve dorsal and ulnar to artery

5%

(183/3699)

3

Nerve medial to artery

6%

(206/3699)

4

Artery ulnar to nerve

2%

(82/3699)

5

Artery dorsal to nerve

80%

(2954/3699)

L 1 D

Select Answer to see Preferred Response

Evidence (1)
VIDEOS & PODCASTS (1)
CASES (1)
EXPERT COMMENTS (16)
Private Note