# Anatomical Variations of the Neurovascular Structures of the Hand and the Clinical Significance

## TL;DR

This study examines anatomical variations in the hand's neurovascular structures and their clinical importance for surgery and diagnostics.

## Contribution

The study provides new insights into sex-based differences in hand anatomy and the prevalence of Berrettini anastomoses.

## Key findings

- Complete superficial palmar arches were more common in males, while incomplete arches were more frequent in females.
- CDP arteries were significantly farther from Kaplan’s line in males compared to females.
- Berrettini anastomoses occurred in 33.3% of hands, with Type III being the most common.

## Abstract

Background

Anatomical variations in the neurovascular structures of the hand have critical implications for surgical procedures, diagnostic accuracy, and nerve conduction studies. This study examined the morphology of the superficial palmar arch (SPA), the course of common digital palmar (CDP) arteries relative to Kaplan’s line, and the prevalence and types of Berrettini anastomosis.

Methods

Thirty-six embalmed cadaveric upper limbs (18 right, 18 left) from the Universities of Belgrade and St Andrews were dissected following standard anatomical protocols. Specimens with visible trauma or deformity were excluded. The SPA was classified as complete or incomplete. Origins of CDP artery distances from Kaplan’s line were measured and analyzed for sex differences using the t- test (p < 0.05). Median-ulnar nerve communications were identified and categorized as Type I (ulnar to median), Type II (median to ulnar), or Type III (bidirectional/multiple).

Results

Complete SPAs were observed in 55.6% (n=20) of specimens, predominantly in males, while 44.4% (n=16) showed incomplete patterns, more frequently in females. CDP arteries were significantly farther from Kaplan’s line in male specimens (p < 0.05). The Berrettini anastomosis was present in 33.3% (n=12) of hands, with Type III being most common (66.7%, n=8/12), and no Type I anastomoses were identified.

Conclusions

Our findings highlight clinically significant variations in hand neurovascular anatomy, with notable sex-based differences in SPA configuration and arterial topography. The frequent occurrence of complex Berrettini anastomoses underscores the importance of detailed anatomical awareness to avoid complications in hand surgery and to enhance diagnostic procedures.