Association of the absence of palmaris longus tendon with an anomalous superficial palmar arch in the human hand.

The normal arterial supply to the human hand is via the ulnar and radial arteries which unite mid-palm to form a complete arch called the superficial palmar arch (SPA). From the SPA blood vessels pass anteriorly to supply the thumb and digits, and deeply to complete the deep palmar arch. Previous reports have documented anomalies of the SPA formation, and this may change the normal blood distribution to the thumb and the digits. There have also been reports of the absence of the palmaris longus tendon. A total of 47 embalmed cadaveric hands (some paired, some single) were dissected and the presence of an anomalous SPA was more frequently observed when the palmaris longus tendon was absent. This may be significant when considering the suitability of patients for hand surgery which involves interruption to the vascular supply to the hand, e.g. harvesting upper limb vessels for coronary artery grafting. The current techniques for assessing the vascular supply to the hand (Aliens test and/or Doppler ultrasounding) are unreliable. Demonstration of a palmaris longus tendon in the living arm is easy and the use of this in combination with the other techniques may improve overall reliability.