Superficial palmar branch of the radial artery in a fibromuscular tunnel: a case report

  • V. Dinesh Kumar
  • Rajasekhar S. S. S. N. Email author
  • Sankaranarayanan G. 
Anatomic Variations


The radial artery usually passes on the radial side of the wrist lateral to the wrist to enter the anatomical snuff box and dorsum of the hand. If the radial artery passes anterior to the wrist, it usually enters the carpal tunnel, and in such cases, it may lead to the compression of the median nerve within the carpal tunnel. During the routine dissection, we found a case of the unusual radial arterial branch that passed anterior to the wrist yet outside the carpal tunnel. The artery passed within a tunnel formed by the fibromuscular fibers of thenar muscles arising from the anterior aspect of the transverse carpal ligament. Knowledge of the course and distribution of the variant superficial palmar branch of radial artery are of importance to the surgeons operating around the wrist, radiologist interpreting angiograms, and orthopedists managing trauma to the wrist.


Carpal tunnel Radial artery Flexor retinaculum Superficial palmar branch Thenar muscles 


Author contributions

Dinesh Kumar V: data collection and manuscript writing. Rajasekar SSSN: data collection and manuscript writing. Sankaranarayanan G: manuscript writing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Barfred T, Hojlund AP, Bertheussen K (1985) Median artery in carpal tunnel syndrome. J Hand Surg Am 10:864–867CrossRefGoogle Scholar
  2. 2.
    Beale EW, Behnam A (2012) Injection injury of an aberrant superficial radial artery requiring surgical intervention. J Hand Microsurg 4:39–42CrossRefGoogle Scholar
  3. 3.
    Birch R (2005) Pectoral girdle and upper limb. In: Standring S (ed) Gray’s anatomy. The anatomical basis of clinical practice, 39th edn. Elsevier, Edinburgh, pp 776–894Google Scholar
  4. 4.
    Chi Z, Yang P, Song D et al (2017) Reconstruction of totally degloved fingers: a novel application of the bilobed spiraled innervated radial artery superficial palmar branch perforator flap design provides for primary donor-site closure. Surg Radiol Anat 39(5):547–557CrossRefGoogle Scholar
  5. 5.
    Gnanasekaran D, Veeramani R (2019) Newer insights in the anatomy of superficial palmar arch. Surg Radiol Anat 41:791–799CrossRefGoogle Scholar
  6. 6.
    Gwynne-Jones DP, Hartnett NI (2008) Aberrant radial artery seen in the carpal tunnel at carpal tunnel decompression: case report. J Hand Surg Am 33:885–887CrossRefGoogle Scholar
  7. 7.
    Ilić M, Milisavljević M, Maliković A et al (2018) The superficial palmar branch of the radial artery: a corrosion cast study. Folia Morphol 77:649–655Google Scholar
  8. 8.
    Kaplanoglu H, Beton O (2017) Evaluation of anatomy and variations of superficial palmar arch and upper extremity arteries with CT angiography. Surg Radiol Anat 39:419–426CrossRefGoogle Scholar
  9. 9.
    Kokkalis ZT, Tolis KE, Megaloikonomos PD et al (2016) Aberrant radial artery causing carpal tunnel syndrome. Arch Bone Jt Surg 4:282–284PubMedPubMedCentralGoogle Scholar
  10. 10.
    Manners-Smith T (1911) The limb arteries of the primates. J Anat 45:23–64Google Scholar
  11. 11.
    McCormack LJ, Cauldwell EW, Anson BJ (1953) Brachial and ante-brachial arterial patterns. Surg Gynecol Obstet 96:43–54PubMedGoogle Scholar
  12. 12.
    Mersa B, Ozçelik B, Kuvat SV et al (2010) An orthopedist course of the radial artery: dissect rather than resect. Indian J Plast Surg 43:228–229CrossRefGoogle Scholar
  13. 13.
    Rodríguez-Niedenführ M, Vázquez T, Nearn L et al (2001) Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat 199:547–566CrossRefGoogle Scholar
  14. 14.
    Sachs M (1987) The arteria radialis superficialis. An unusual variation of the arteria radialis of man and its phylogenetic significance. Acta Anat (Basel) 128:110–123CrossRefGoogle Scholar
  15. 15.
    Singer E (1933) Embryological pattern persisting in the arteries of the arm. Anat Rec 55:403–409CrossRefGoogle Scholar
  16. 16.
    Singer G, Marterer R, Till H et al (2018) A rare anatomic variation of the superficial palmar branch of the radial artery causing pain. Surg Radiol Anat 40:349–352CrossRefGoogle Scholar
  17. 17.
    Tagil SM, Bozkurt MC, Kuvat SV et al (2012) A variant course of the superficial palmar branch of the radial artery. Surg Radiol Anat 34:871–873CrossRefGoogle Scholar
  18. 18.
    Uglietta JP, Kadir S (1989) Arteriographic study of variant arterial anatomy of the upper extremities. Cardiovasc Inter Radiol 12:145–148CrossRefGoogle Scholar
  19. 19.
    Varley I, Wales CJ, Carter LM (2008) The median artery: its potential implications for the radial forearm flap. J Plast Reconstr Aesthet Surg 61:693–695CrossRefGoogle Scholar
  20. 20.
    Wood SJ, Abrahams PH, Sañudo JR et al (1996) Bilateral superficial radial artery at the wrist associated with a radial origin of a unilateral median artery. J Anat 189:691–693PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of AnatomyJIPMERPuducherryIndia

Personalised recommendations