Circulatory patterns in the normal hand

Abstract

Abstract Circulation in 100 apparently normal hands was studied clinically by the use of the Allen test and ultrasonically with a Doppler flowmeter. Circulatory dynamics in the hand were found to follow a very variable pattern, the ulnar artery being the dominant source of supply in most hands. It was concluded that collateral circulation in the hand would generally maintain viability of the fingers when either the radial or ulnar artery was occluded at the wrist. In 9 per cent of hands, however, there was evidence of more drastic disturbance of the circulation on occlusion of the ulnar artery, and in 6 per cent the same finding was made upon occlusion of the radial artery. The Allen test was positive in only 3 per cent of the hands, and in each case the ultrasonic examination confirmed the dependence of the digital circulation on a single artery at the wrist. It is suggested that these variations in collateral adequacy in the hand may explain ischaemic phenomena seen in some patients with the ‘hammer-hand’ syndrome, in a few patients after radial artery cannulation for monitoring purposes, and in a somewhat higher percentage of patients having arteriovenous fistulae constructed at the wrist for long-term haemodialysis. It is also suggested that patients undergoing procedures which will distort radial artery haemodynamics in the hand should be screened to test collateral adequacy.