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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
Arch Kaplan'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
 

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