Anat Cell Biol.  2019 Sep;52(3):349-353. 10.5115/acb.19.061.

A case of potentially lethal vascular variation in association with palmaris profundus muscle

• Gaikwad MR
• Ravi PK
• Patnaik M

• KMID: 2459553
• DOI: http://doi.org/10.5115/acb.19.061

Abstract

Arterial variations in upper limbs are often reported commonly. Superficial arterial variations accounting for 4.2% of all arterial variations are hazardous during any invasive procedures of the upper limb, from routine intravenous injections to surgeries. Arterial variations are usually associated with inverted or absent palmaris longus. Palmaris profundus, a rare anomalous variation of palmaris longus has been reported in carpal tunnel syndrome as its tendon was associated with median nerve in the carpal tunnel. The authors reported a unique variation in the upper limb arterial pattern"”the presence of bilateral superficial brachioulnar artery associated with unilateral palmaris profundus muscle and an abnormal radicle of musculocutaneous nerve to the median nerve in the left side.

Keyword

Superficial brachioulnar artery; Palmaris profundus; Palmaris longus; Arterial variation

MeSH Terms

Arteries
Carpal Tunnel Syndrome
Injections, Intravenous
Median Nerve
Musculocutaneous Nerve
Tendons
Upper Extremity

Figure

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  Fig. 1 Photograph of ventral aspect of the right upper limb. (A) Arm showing superficial brachioulnar artery (SBUA) arising from brachial artery (B) just above the level of insertion of coracobrachialis (CB). (B) In the right elbow, SBUA was superficial to pronator teres muscle and continued as the superficial ulnar artery in cubital fossa. In right mid-forearm SBUA passes deep to palmaris longus (PL) (blue arrow showing distal end of PL) and palmaris profundus (green arrow showing distal end of palmaris profundus). Panels C and D are coloured photographs of panels A and B. CH, circumflex humeral artery; CI, common interossei artery; MCN, musculocutaneous nerve; MN, median nerve; R, radial nerve; SPA, superficial palmar arch.

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  Fig. 2 Photograph of ventral aspect of left upper limb. (A) In forearm, superficial brachioulnar artery (SBUA) passes deep to palmaris longus (PL) (blue arrow) and its contribution to superficial palmar arch (SPA) was as normal as ulnar artery. (B) Arm showing SBUA originating from the third part of axillary artery (A) proximal to the origin of anterior and posterior circumflex humeral arteries. Panels C and D are colored photographs of panels A and B. BB, biceps brachii; MCN, musculocutaneous nerve; MN, median nerve; CI, common interossei artery; R, radial nerve.

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  Fig. 3 Photograph showing ventral aspect of dissected and colored right upper limb. Palmaris longus (PL) is unusually fleshy up to mid-forearm level (blue arrow pointing distal end of fleshy PL). Palmaris profundus originating from under the surface of PL, distal fleshy part in the distal third of forearm pointed in green arrow below PL tendon. In the level of flexor retinaculum (black star), tendon of PL (blue star) goes superficial to flexor retinaculum and tendon of Palmaris profundus (green star) lies deep to flexor retinaculum. MN, median nerve; R, radial nerve; SBUA, superficial brachioulnar artery; SPA, superficial palmar arch.

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