Anatomic Landmarks to the Superficial and Deep Palmar Arches
Kia M. McLean, MD, Justin M. Sacks, MD, Yur-ren Kuo, MD, Ronit Wollstein, MD, J. Peter Rubin, MD, and W. P. Andrew Lee, MD
INTRODUCTION: The superficial and deep palmar arches have intrigued anatomists and physicians for centuries (1-3). Most studies of the palmar arches to date have focused on anatomical variations of the arches (3-5). However, with the advent of microsurgery and innovations in the carpal tunnel release, the relationship of the palmar arches in reference to anatomical landmarks is of increasing importance (4,6). The purpose of our study was to identify the location of the palmar arches in relation to surface and bony landmarks in the hand.
METHOD: Surface landmarks of the distal wrist crease and Kaplan's cardinal line were marked on 48 fresh cadaver hands. Kaplan's cardinal line was defined as the transverse line drawn from the ulnar border of the thumb extending to the hook of hamate (4). A longitudinal line was marked extending from the radial border of the ring finger. Incisions were made along the palmar surface landmarks and skin flaps were raised. The superficial palmar arch (SPA) was identified under the palmar aponeurosis, and the deep palmar arch (DPA) was located under the floor of the carpal tunnel. The most distal points of the palmar arches were measured in relation to Kaplan's line, the distal wrist crease (DWC), and carpometacarpal (CMC) joint of the ring finger. Subsequently, 30 arteriograms of the upper extremity were examined. The distances from the radiocarpal joint to the superficial and deep palmar arches were measured. (Figure 1).
RESULTS: The SPA was found to be on average 15.3 mm (+/- 8.60 mm) distal to Kaplan’s line. The DPA, however was only on average 6.70 mm (+/- 4.82 mm) distal to Kaplan’s line. The SPA was distal to Kaplan’s line in 48 out of 48 cases and the DPA was distal to Kaplan’s line in 47 out of 48 cases.
The SPA was found to be on average 51.8 mm (+/-7.56 mm) distal to the (DWC). The DPA was on average 40.1 mm (+/- 7.92 mm) distal to the DWC. The average distance from the SPA to the (CMC) joint of the ring finger was 32.2 mm (+/- 6.33 mm). The average distance from the DPA to the CMC joint of the ring finger was 18.3 mm (+/- 4.64 mm).
On arteriogram, the SPA was on average 50.3 mm (+/-8.61mm) from the radiocarpal joint, when a perpendicular line was drawn from the midline of the radius to the arch. However, the DPA was on average only 44.89 mm (+/-4.77 mm), from the radiocarpal joint when a perpendicular line was drawn from the middle of the radius to the arch.
CONCLUSION: Injuries to vital vascular structures in the hand can occur during routine and intricate procedures. We investigated the location of the SPA and DPA in reference to surface and bony landmarks in the hand by gross dissection and arteriogram. The SPA and DPA were noted to be consistent distances from easily identifiable surface and bony landmarks in the hand. Knowledge of these predictable anatomic relations can aid clinicians in microsurgical procedures, treatment of vasooclusive disease, interpretation of arteriograms, and avoidance of iatrogenic injury during the carpal tunnel release.
Figure 1. Superficial Palmar Arch
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