Anatomic Study of Arborization Patterns of the Ulnar Artery in Guyon’s Canal

doi:10.1016/j.jhsa.2005.11.004

The Journal of Hand Surgery

Volume 31, Issue 2, February 2006, Pages 258-263

https://doi.org/10.1016/j.jhsa.2005.11.004 Get rights and content

Purpose

To show variations in arborization patterns of the ulnar artery in Guyon’s canal and to investigate the relationship between the hypothenar muscles and the ulnar artery.

Methods

Thirty-five embalmed cadaveric hands were dissected and the existence and course of the superficial and deep palmar branches of the ulnar artery and the site of feeding branches to the hypothenar muscles were recorded. The anatomic relationship between the ulnar artery and the hypothenar muscle variations also was investigated.

Results

Four arborization patterns were identified. In type 1UA (n=17 hands), an artery accompanying the deep branch of the ulnar nerve (AADBUN) formed a deep palmar arch (DPA). In type 2UA (n=11 hands) the AADBUN continued to the feeding artery of the abductor digiti minimi and the distal deep palmar branch of the ulnar artery (DDPBUA) branched off distally. This arterial structure formed a DPA. In type 3UA (n=6 hands) both the AADBUN and DDPBUA formed DPAs. In type 4UA(n=1 hand), the AADBUN continued to the feeding artery of the abductor digiti minimi with no DDPBUA and therefore no DPA. A dorsal perforating artery of the ulnar artery also was found in 4 hands. This branch came from the AADBUN at the level of the distal edge of the pisiform and merged with the dorsal carpal arterial arch. We also investigated the relationship between the structural pattern of the hiatus for the deep branch of the ulnar nerve and ulnar artery variation but found no association. The most common pattern observed was a type 1 hiatus with a type 1UA arborization pattern.

Conclusions

Our study confirmed considerable variations in the arborization pattern of the ulnar artery in Guyon’s canal. To avoid injury to the arterial branches during surgery in this region care must be taken with respect to variations of the ulnar artery in Guyon’s canal.

Section snippets

Materials and Methods

Thirty-five embalmed cadaveric hands were dissected under loupe magnification (×3.5, Designs for Vision, Inc., Ronkonkoma, NY); 15 hands were paired bilaterally. After removing the skin of the distal forearm and palm a radial-based flap (roof of Guyon’s canal) containing subcutaneous tissue, the fascia of the abductor digiti minimi (ADM), and the palmaris brevis was elevated to expose the hypothenar muscles and the ulnar neurovascular bundle. We recorded the following: (1) the existence and

Anatomic Variations of the Ulnar Artery and Its Branches

In all hands the ulnar artery continued distally to the superficial palmar arch (SPA), which started after the ulnar artery branched off the deep branches of the ulnar artery. Four arborization patterns of the ulnar artery in Guyon’s canal were identified: 1UA, 2UA, 3UA, and 4UA (Fig. 1). In type 1UA (17 hands) an artery accompanying the deep branch of the ulnar nerve (AADBUN) passed through the hiatus and formed a deep palmar arch (DPA). No other branches entered the midpalmar space distally.

Discussion

The deep branch of the ulnar artery has been described previously in different ways. For example some describe it as being accompanied by the DBUN, which passes through the hiatus,11, 12, 13 whereas others suggest no artery is accompanied by the DBUN, with the deep branch of the ulnar artery branching off more distally.6, 8, 14, 15 According to the anatomic investigation of cadaveric specimens by Coleman and Anson¹ the inferior deep branch of the ulnar artery passed superficially to the FDMB

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Cited by (13)

Ulnar Neuropathy (Wrist)
2018, Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation
Entrapment of the ulnar nerve at the wrist in the piso-hamate hiatus or Guyon canal occurs rarely but is a condition that the clinician should be able to identify via an appropriate history and physical examination in addition to electrodiagnostic evaluation. Although much less common than the typical ulnar neuropathy at the elbow, this condition may be encountered in individuals who are involved in a physical activity that places excessive pressure on the hypothenar area of the hand or, even more rarely, due to a space-occupying lesion. There are different presentations depending at what level of the Guyon canal the compression occurs and which branches are affected with motor and sensory findings varying. In the worst cases, there is severe functional loss due to atrophy and weakness of the intrinsic muscles. Knowledge of the typical anatomy of the ulnar nerve allows the clinician to differentiate this entity from the more common lesion at the elbow, especially when there is sensory sparing of the medial dorsal aspect of the hand in dorsal ulnar cutaneous nerve distribution as this branches proximal to the Guyon canal. Careful electrodiagnostic evaluation via nerve conduction study and electromyography serves to confirm and to classify the condition and space-occupying lesions can be more reliably evaluated via modern imaging technology including magnetic resonance imaging and sonography. Treatment can range from measures to avoid trauma to the hypothenar area to the use of nonsteroidal anti-inflammatory drugs and rehabilitation therapy/static splinting to local injection and surgery in certain cases where compression is due to a space-occupying lesion in the Guyon canal.
Anatomy and function of the hypothenar muscles
2012, Hand Clinics
Citation Excerpt :
This branch continued distally as the DPA, which provided feeder branches to the ODM. The FDM received its blood supply from a feeder branch off the SPA.16 The DDPBUA has been identified in previous studies as well.
Hypothenar eminence
2010, Chirurgie de la Main
L’éminence hypothénar est d’un grand intérêt chirurgical et reste pourtant insuffisamment connue dans son anatomie complexe. Cette étude est une mise au point concernant : le socle ostéoligamentaire et la topographie de la loge et du canal de Guyon. Le canal pisohamulien mérite d’être individualisé. Il correspond à la zone 2 de Shea et McClain où le rameau profond du nerf ulnaire est particulièrement vulnérable. Décrit habituellement comme un orifice, il s’agit d’un véritable canal qui contourne l’hamulus ; les muscles hypothénariens sont extrêmement variables. Le court abducteur de l’auriculaire est utilisé comme transfert d’opposition mais son absence pénalise l’abduction de ce doigt si le court fléchisseur, indépendant, achève son trajet sur la tête du cinquième métacarpien ; la terminaison du nerf ulnaire, sa distribution aux muscles hypothénariens et les anastomoses médio-ulnaires ; l’artère ulnaire, ses rapports étroits avec l’hamulus de l’hamatum et les variations de son trajet qui parfois l’exposent lors de la chirurgie endoscopique du canal carpien ; enfin les téguments, coussinet adipeux et peau, que leur vascularisation autorise à utiliser comme lambeaux de couverture à la paume ou aux doigts.
The hypothenar eminence is of great surgical interest yet its complex anatomy is yet to be fully discovered. This review focuses on: the osteoligamentous floor and topography of the Guyon's canal and the carpal ulnar neurovascular space. The canal under the Pisohamate ligament must be individualized. It corresponds to the zone 2 of Shea and McClain where the deep branch of the ulnar nerve is particularly vulnerable. Usually described as a hole, it is a real canal that circumvents the hamulus; the hypothenar muscles are extremely variable. The short abductor of the little finger may be harvested for opposition transfer but its absence penalizes abduction of the little finger if an independent flexor digiti minimi brevis inserts on the head of the fifth metacarpal; the termination of the ulnar nerve distribution to the hypothenar muscles and medio-ulnar anastomoses. The ulnar artery, its close relationship with the hook of the hamate and its variable course that may put it at risk during endoscopic carpal tunnel release. Finally, blood supply of fat pads and skin and their use as flaps to cover the palm and fingers.
Ulnar Neuropathy (Wrist)
2008, Essentials of Physical Medicine and Rehabilitation
Ulnar Neuropathy (Wrist)
2008, Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation, Second Edition
Ultrasound of the Hook of Hamate Region: Pictorial Review
2023, Journal of Ultrasound in Medicine

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WristAnatomic Study of Arborization Patterns of the Ulnar Artery in Guyon’s Canal

Purpose

Methods

Results

Conclusions

Section snippets

Materials and Methods

Anatomic Variations of the Ulnar Artery and Its Branches

Discussion

Hand

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Arterial patterns in the hand based upon a study of 650 specimens

Surg Gynecol Obstet

Arterial anatomy of the upper extremity

Acta Radiol Diag

Wrist
Anatomic Study of Arborization Patterns of the Ulnar Artery in Guyon’s Canal