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Neurovasculature of the hand

Arteries, veins and nerves of the hand.

Show transcript

Hello, everyone. This is Joao from kenhub, and welcome to another anatomy tutorial where, today, we’re going to be covering the neurovasculature of the hand. Now, what I'm going to be doing is describing the different structures, different blood vessels, and also nerves that we’re going to be finding here on your hand. So we’re going to look at a list of arteries, veins, and nerves that you find on your hand.

And without further ado, let’s start off with the first one on the list: the arteries, which I'm going to list them before we go into more detail on this tutorial. But do not be scared. They’re quite simple to understand. But these arteries include the superficial and deep palmar arches, the dorsal carpal arch, the common and proper palmar digital arteries, the dorsal metacarpal arteries, the dorsal digital arteries, and finally, the principal artery of the thumb.

We are going to start off with the first one the list. These two arches that you see here, highlighted in green. On the left side, we have the superficial palmar arch, and on the right side, you see, highlighted in green, the deep palmar arch. And the arterial arches of the hand are networks of arteries that work as terminal anastomosis for the ulnar and radial arteries. They are found on the palmar side of your hand and give off branches for blood supply of the palmar side of your fingers.

And let’s take a closer look here at the superficial palmar arch. And this one is formed by terminal segments of the ulnar artery as you can see here on this image. This is the ulnar artery and also superficial palmar branch of the radial artery, which you can also see here on this image, so this is the radial artery. You can notice here a bit of the radius and the ulna for a bit more location.

The superficial palmar arch gives off the common palmar digital arteries to the fingers except the thumb. And you can clearly see here, also on this image, the different palmar digital arteries just branching off this arch, as you can see here, but nothing going towards the thumb. So there is a different supply here that we will be talking about later on on this tutorial.

And if we go a bit more distally, then we’re going to be finding these that you see now, highlighted in green. These are the common palmar digital arteries which I just mentioned before on the previous slide. The common palmar digital arteries are branches of that arch that we talked about, the superficial palmar arch that you can see also here on this image clearly.

Now, they run down until the root of the finger where they will split into, then, the proper palmar digital arteries, which are the next arteries that we’re going to be highlighting here. These are, then, the proper palmar digital arteries. And these arteries as we’ve seen on the previous slide are branches of the common palmar digital arteries. And they run along the sides of the phalanges and lay just dorsally to the corresponding digital nerve.

But one clarification here is that, as you can see here on the thumb, the proper palmar digital arteries for this structure will be, then, coming from this artery here, which we will talk about later, which is known as the principal artery of the thumb.

Also important to add about the proper palmar digital arteries is that they supply the distal regions of your fingers, and end freely within the tissue of the fingertips, and additionally, give off small branches to the dorsum of the fingers.

Now, as I mentioned before, I just briefly talked about this one that you see now, highlighted in green. Here, this artery which is known as, then, the principal artery of the thumb. Maybe you have wondered why the thumb isn’t supplied by the digital arteries. Well, the reason is the thumb is or has its own artery: the principal artery of the thumb, which branches off from the radial artery and splits into two branches running along the thumb.

The next structure that we’re going to talk about and seen now, highlighted in green, is known as—you probably remember—as the deep palmar arch. This is formed by the terminal segment of the radial artery and the deep palmar branch of the ulnar artery.

In addition to the small terminal branches for the surrounding tissue, the deep palmar arch will give off the palmar metacarpal arteries, as you can see here on this image. So these are the palmar metacarpal arteries which, then, anastomose distally with the common palmar digital arteries from the superficial arch that we talked about before and then separate at the root of the fingers as the proper palmar digital arteries.

Now, we’re going to turn the hand and show the dorsal portion of the hand. And the structures that we can see here now, the arterial structures that we will see on the dorsal side of the hand. And this one that we’re highlighting right now is known as the dorsal carpal arch. And like the palmar arches, there is one dorsal carpal arch at the back of your hand. It is made up by the dorsal carpal branch of the radial artery and the dorsal carpal branch of the ulnar artery just at the back of the wrist.

Now, this arch will then anastomose with the anterior and posterior interosseous arteries. And like the superficial palmar arch, it will give off the metacarpal arteries, the dorsal metacarpal arteries to be more precise.

And we’re going to, then, talk about the dorsal metacarpal arteries that you see now highlighted in green. And as I mentioned, they come from then the dorsal carpal arch and run alongside the metacarpal bones. And like the common palmar digital arteries, they will split up into dorsal digital arteries. And in addition, they give small branches that anastomose with the common palmar digital arteries and, thus, connecting the dorsal carpal arch with the superficial palmar arch.

We’re going to move on a bit further distally to, then, see these that you see now, highlighted in green. These are known as the dorsal digital arteries. And these arteries are the continuation of the dorsal metacarpal arteries, and they run along the sides of the dorsum of the fingers, towards the end of the phalanges. They run alongside with the dorsal digital nerves of the ulnar and radial nerves.

We’re now ready to move on to these veins of the hand. This consists of the superficial and deep palmar venous arches, the dorsal venous network of the hand, and the palmar metacarpal digital veins.

Now, let’s start off with the very first one. And as you can see here, the venous blood draining system of the hand is very similar to the arterial system. We’re now looking at superficial and deep palmar venous arches. They’re combined here in this highlight. There is also a superficial and deep palmar venous arch as we compare with then the arterial arches. And they get blood from the common palmar digital veins and drain it into the ulnar and radial veins. So the superficial arch will be draining into, then, the ulnar vein, and the deep arch will be draining into the radial vein.

Now, we’re going to look at this that you see, highlighted in green. We just cleared up a few of the arches to now highlight the palmar metacarpal and digital veins. The palmar metacarpal and digital veins are positioned close to their corresponding arteries and drain into the palmar venous arches.

Now, we’re turning the hand again to the back of the hand. Now, we’re looking at it from a dorsal view to, then, show you this network, the dorsal venous network of the hand. And this network gets blood from the dorsal metacarpal veins and then takes it towards the basilic and cephalic veins of the forearm.

We are now ready to talk about the different nerves that we find on your hand. And before we do so, I would like to also list them. These include then the common and proper palmar digital nerves of the median nerve. We’re going to also see the superficial, deep, and dorsal branches of the ulnar nerve.

Now, let’s start off with the first one that you see here, highlight ... or the first ones that you see, highlighted in green, which are known as the proper palmar digital nerves of the median nerve.

The lateral portion of the median nerve, which is this nerve that you see here—you see a portion of it coming from the forearm—supplies then a short, stout branch to certain muscles of the ball of the thumb and then divides it into three proper palmar digital nerves, as you can see here on this image. So we, then, call them the proper palmar digital nerves of, then, the median nerve. We can also call them proper volar digital nerves.

Now, two of these as you can see on the image will be supplying the sides of the thumb. While the third one, as you can see as well, will be distributed to the radial side of the index finger.

At the end of each finger that these nerves will be found, the proper digital nerve divides into two branches. And one will supply the pulp of the finger, while the other will ramify around and beneath the nail. The proper digital nerves, as they run along your fingers, they are located superficially to the corresponding arteries.

Now we’re moving on to another nerve that we’re going to be... or nerves that we will be highlighting here. These are known as superficial branch of the ulnar nerve. And this superficial branch of the ulnar nerve is a terminal branch of this nerve. And you can also see here on the image the ulnar nerve coming from the forearm.

The superficial branch of the ulnar nerve will be supplying different structures, are innervating these muscles that you see here, highlighted in green, the palmaris brevis, and also the skin on the ulnar side of the hand.

The superficial branch of the ulnar nerve divides into a common palmar digital nerve and also a proper palmar digital nerve. As you can see here on this image, the division happening here, the common palmar digital nerves, and then closer to your fingers, you have, then, the proper palmar digital nerves coming from the superficial branch of the ulnar nerve.

The proper digital branches are distributed to the fingers in the same manner as we’ve seen on the median nerve.

There is also this one that you see here, highlighted in green. This is known as, then, the deep branch of the ulnar nerve. The deep branch of the ulnar nerve is a terminal, primarily motor branch of the ulnar nerve. It is found next to, then, the deep palmar branch of the ulnar artery.

Now, there is a list of muscles that will be innervated by the deep branch of the ulnar nerve. And these include the hypothenar muscles. As it crosses the deep part of the hand, it will also innervate the interossi muscles and the third and fourth lumbricals. It will also be innervating the adductor pollicis and the medial head of the flexor pollicis brevis. The deep branch of the ulnar nerve will also send articular filaments to the wrist joint.

It’s time for us to move on to another structure: this time, on the dorsal side as I turn or twist the hand here to show you the dorsal branch of the ulnar nerve. The dorsal branch of the ulnar nerve arises five centimeters proximal to the wrist. It divides into two dorsal digital branches.

This branch will then supply the ulnar side of the little finger and the adjacent sides of the little and ring fingers. With the superficial branch of the radial nerve, it will be supplying the adjoining sides of the middle and ring fingers. And the branch will also be distributed to the metacarpal region of the hand, communicating with the twig of the superficial branch of the radial nerve.

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