Cardiovascular system · Upper limb

Superficial palmar arch !

The superficial palmar arch is a loop of artery under the palm's tough sheet, mainly from the ulnar artery; it sends blood to the fingers.

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What it is

An arch of artery across the palm just beyond the carpal tunnel; surgeons keep it safe during carpal tunnel release.

What it does

Sends blood to the fingers; it lies just beyond the carpal tunnel.

Key facts

Origin

Mainly the ulnar artery (+ superficial palmar branch of the radial artery)

Branches

Common palmar digital arteries

Supplies

Fingers; level with the distal border of the abducted thumb (Kaplan's line)

Relations

Course

The ulnar artery leaves the Guyon canal, gives off its deep palmar branch and curves laterally across the palm toward the thenar eminence, where it meets a radial branch (superficial palmar, princeps pollicis or radialis indicis)

Superficial

Palmar aponeurosis, palmaris brevis on the ulnar side, and skin

Deep

Long flexor tendons, lumbricals and the digital nerves (branches of the median and ulnar nerves)

How to find it

Not felt as a pulse. Lines drawn on the palm are used to estimate where it lies when planning incisions; Doppler ultrasound shows the arch and its flow directly.

Examination

• Allen test: after the palm blanches, each wrist artery is released in turn; slow refilling from one side suggests the arch does not link the two sources

On imaging

Doppler ultrasound shows it just deep to the palmar aponeurosis, roughly level with the distal border of the fully extended thumb. CT, MR or catheter angiography show whether the arch is complete, which matters before radial artery harvest, and reveal emboli or aneurysm in hypothenar hammer syndrome. Radiographs only show calcified arteries, as in diabetes or chronic kidney disease.

Clinical notes

• Because the arch fills from both sides, a cut through it bleeds from both ends, and both ends are controlled
• When the arch is incomplete, losing one forearm artery (after access, harvest or a dialysis fistula) is more likely to leave fingers short of blood
• Hypothenar hammer syndrome damages the ulnar artery where it begins the arch over the hook of the hamate, sending clots to the fingers
• Surgery for Dupuytren disease works just above the arch and the common digital vessels

Anatomical variants

• Complete in most hands but incomplete in a sizeable minority, more often than the deep arch; reported rates vary widely with the definition used
• Patterns include the classic radio-ulnar arch, an arch formed by the ulnar artery alone and arches joined by a persistent median artery

Development

Early in development the median artery, running with the median nerve, is the main supply of the forearm and palm; it normally regresses once the radial and ulnar arteries grow. If it persists, it can pass through the carpal tunnel and join this arch.

Related conditions

• Raynaud phenomenon

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Educational information, not medical advice. For any symptom, see a health professional.

Its names

Official Latin (TA2)

arcus palmaris superficialis TA2 4671

Official Spanish (DeCS)

Arco palmar superficial

English (TA2)

Superficial palmar arch

Related

• Flexor retinaculum
• Palmar aponeurosis
• Lumbricals
• Abductor digiti minimi
• Flexor digiti minimi

Sources: Terminologia Anatomica (TA2); Anatomy, Shoulder and Upper Limb, Hand Volar Arch Arteries; Anatomy of the Human Body (20th ed.): Development of the Vascular System (Lea & Febiger (Gray's Anatomy, 1918), 1918) · adapted, Public domain; Tratado de anatomía humana (9.ª ed.), tomo II, Libro IV Angiología, arterias subclavia, axilar, humeral, radial y cubital, arcos palmares y vías anastomóticas del miembro superior.

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Representative model, for educational purposes only.