Journal of Plastic, Reconstructive & Aesthetic Surgery (2007) 60, 1120e1126

The vascular anatomy of the lumbrical

muscles in the hand
Okan Bilge*, Yelda Pinar, Mehmet Asim Ozer, Figen Govsa

Department of Anatomy, Faculty of Medicine, Ege University, 35100 Bornova, Izmir, Turkey

Received 8 June 2005; accepted 8 June 2006

KEYWORDS Summary The lumbrical muscles are located in the midpalm, dorsal to the palmar
Lumbrical muscle; aponeurosis. The main function of these muscles is an indirect contribution to in-
Vascular anatomy; terphalangeal joint extension by decreasing the flexor effect of the flexor digitorum
Superficial palmar profundus muscle. Due to their minor biomechanical functions and suitable con-
arch; structions, these muscles have been preferred in reconstructive surgery as local
Deep palmar arch transposition flaps or pedicled flaps. Despite the surgical and clinical importance,
vascular anatomical studies of these muscles are not well represented in the cur-
rent literature.
This study was performed in the Department of Anatomy of the Faculty of Medicine
of the Ege University. Thirty-four cadaver hands, injected with red-coloured latex
were used, and we aimed to describe the morphometry and vascular anatomy of
the lumbrical muscles. We measured the length and width of the muscles, after re-
moving their epimisium, and the diameter and length of the arteries to the muscles.
The outcomes of our study determined that the length and width of the lumbrical
muscles were reduced significantly from radial towards ulnar sides. The lumbrical
muscles were supplied from both their palmar and dorsal surfaces by both superficial
and deep palmar arches and/or their branches. We also described the level of entry of
the dominant arteries for each lumbrical muscle and measured the size of the vessels
and muscles to guide some surgical approaches.
This anatomical study could guide for some surgical approaches and reduce the
deficiency about the vascular anatomical patterns of the lumbrical muscles in the
literature.
ª 2006 British Association of Plastic, Reconstructive and Aesthetic Surgeons.
Published by Elsevier Ltd. All rights reserved.

The lumbrical muscles are located in the midpalm,

dorsal to the palmar aponeurosis. These four tiny
* Corresponding author. Tel.: þ90 232 390 39 88. muscles are cylindrical and originate from the flexor
E-mail address: okan.bilge@ege.edu.tr (O. Bilge). digitorum profundus (FDP) tendons. The first radial

1748-6815/$-seefrontmatterª2006BritishAssociationof Plastic,ReconstructiveandAestheticSurgeons.PublishedbyElsevierLtd.All rightsreserved.

doi:10.1016/j.bjps.2006.06.023
The vascular anatomy of the lumbrical muscles in the hand 1121

one is always, and the second one occasionally, After measuring and classifying the arteries of
unipennate; the ulnar two are bipennate on their the palmar surface, the transverse carpal ligament
origins. Each muscle crosses over the metacarpopha- was opened and the flexor tendons were cut and
langeal (MP) joint from its radial side and attaches elevated to explore the dorsal arteries of the
on the radial margin of the corresponding finger.1e3 lumbrical muscles.
The main function of these muscles is an in-
direct contribution to interphalangeal joint exten- Results
sion by decreasing the flexor effect of the FDP
muscle. They are also weak MP joint flexors and Red-coloured latex injection into the arteries
assisting the interosseous muscles.1,4,5 revealed all supplier arteries of the lumbricals
Due to the minor biomechanical functions and clearly and helped for accurate dissection. It was
suitable constructions, these muscles have been found that the muscles received blood from both
preferred in reconstructive surgery as local trans- their palmar and dorsal surfaces by both the
position flaps or pedicled flaps.6,7 superficial and deep palmar arches and their
Additionally, ischaemia of the mid-palmar area branches.
due to transmetacarpal injuries such as crush
injuries, direct traumas or guillotine amputations
and poor functional results seen after transmeta-
carpal replantations and revascularizations have
a direct relevance to the vascular anatomy of the
intrinsic muscles.8e10
Despite the surgical and clinical importance,
vascular anatomical studies of these muscles are
not well represented in the current literature.

Materials and methods

The morphometry and vascular anatomy of the

lumbrical muscles were investigated in 34 formalin
fixed hands of three female and 14 male human
cadavers, ranging in age from 30 to 72 years with no
evidence of macroscopic pathology. The cadavers
were supplied by the Department of Anatomy of the
Faculty of Medicine of the Ege University. In all
hands, the radial and ulnar arteries were injected
with red-coloured latex appropriately. The palmar
surfaces of the hands were carefully dissected with
the aid of a dissecting loop (magnification  2,5) to
see clearly the arterial vasculature. For this pur-
pose, the palmar aponeurosis and fat tissue were
removed, and the superficial palmar arch (SPA)
and its branches and the participating rami of the
radial artery (in existence) were exposed.
All lumbrical muscles and the entry of arteries Figure 1 The arteries to the posterior surface of the
into the palmar surfaces of the muscles were second to fourth lumbrical muscles (II, III, IV) of a left
clearly identified from their origin up to the hand. DPA: deep palmar arch, *: fourth palmar metacar-
insertion point. The length and width of the pal artery (fourth PMCA), **: third palmar metacarpal
muscles were measured after removing their epi- artery (third PMCA), 1: a branch from the third PMCA
to the middle third of the second lumbrical muscle,
misium. The length and diameters of the entering
2,3: branches from the third PMCA to the middle third
arteries were also measured. Measurements were
of the third lumbrical muscle, 4: a branch from the
made with the aid of a digital calliper. fourth PMCA to the middle third of the fourth lumbrical
The muscles were divided into three equal parts muscle, 5: the short trunk from the DPA that divides into
on their lengths as proximal, middle and distal and two branches; 5i to the proximal third of the second
the arteries were classified according to their lumbrical muscle and 5ii to the proximal third of the
entry points to the muscle. third lumbrical muscle.
1122 O. Bilge et al.

Table 1 The origins and entering zones of the arteries to the first lumbrical muscle
First LM SPA First CPDA ARI CB DPA First PMCA Second PMCA
Prox. N 18 11 4 3
third D/L (mm) 0.77/8.37 0.77/8.64 0.63/19.32 0.71/14.37
Mid. N 2 9 21 2 1 1
third D/L (mm) 0.54/11.25 0.71/9.51 0.73/10.70 0.76/21.23 1.20/9.20 0.68/18.54
Dist. N 2 13 3
third D/L (mm) 0.62/12.52 0.71/6.74 0.73/4.73
The total numbers (N) and mean diameters and lengths (D/L) are stated.

The arteries of the palmar surface originated

directly from the SPA and/or from common palmar
digital arteries (CPDA). Similarly, the dorsal sur-
face arteries originated mostly from the deep
palmar arch (DPA) and rarely from palmar meta-
carpal arteries (PMCA). In some hands, a common
trunk from the DPA on the dorsal surface was
detected. This trunk was very short and occasion-
ally divided into two branches for the second and
third lumbrical muscles (Fig. 1).

First lumbrical muscle

The first lumbrical muscle was unipennate in all

investigated specimens and originated from the
radial side of the index finger FDP tendon. The
mean length of the first lumbrical muscle was
59.69  5.77 mm (ranged from 51.03 mm to
71.22 mm), and the mean width was 8.23 
1.34 mm (ranged from 5.99 mm to 11.32 mm).
All three parts of this muscle receive several
arteries from SPA, DPA, first and second PMCA, first
CPDA, arteria radialis indicis (ARI) and a communi-
cating branch (CB) between SPA and arteria
princeps pollicis (Table 1).
Dominant branch or branches mostly entered
the muscle from the proximal and middle third and
originated from SPA and CB, respectively. The first
lumbrical muscle is supplied from its palmar
surface (Fig. 2A).
The mean diameters of the arteries from SPA
and CB to the proximal third of the muscle were
0.76  0.20 mm and 0.77  0.14 mm, and the mean
lengths were 8.37  3.24 mm and 8.65  2.08 mm,
respectively. Figure 2 (A) A dominant artery (black arrow) from the
The other arteries to the first lumbrical muscle communicating branch (*) between superficial palmar
and their origins are presented in Table 1 and arch (SPA) and arteria princeps pollicis (app) to the first
demonstrated in Fig. 2B. lumbrical muscle (I) of a right hand. First CPDA: first
common palmar digital artery, second CPDA: second pal-
mar digital artery, and t: tendon to index finger of flexor
Second lumbrical muscle digitorum profundus muscle. (B) The proportions of the
common arteries that give off either dominant or non-
The second lumbrical muscle was mostly unipen- dominant branches to the first lumbrical muscle. SPA:
nate (88.24%), but in four hands (11.76%) had an superficial palmar arch, CB: communicating branch,
additional point of origin from the first FDP tendon and ARI: arteria radialis indicis.
The vascular anatomy of the lumbrical muscles in the hand 1123

and is defined as bipennate. The mean width was

6.66  1.29 mm (ranged from 4.07 mm to 9.39 mm)
and the mean length of the second lumbrical mus-
cle was 52.97  5.26 mm (ranged from 41.87 mm
to 66.34 mm).
This muscle receives blood mainly from SPA, DPA,
first CPDA and second and third PMCA. The muscle
was supplied by between one and three dominant
arteries that were branching mostly from the first
CPDA on the palmar side and DPA on the dorsal side
and entering to the middle and proximal third of the
muscle, respectively (Fig. 3A).
The mean diameter and length of the dominant
branches from first CPDA were 0.67  0.17 mm and
8.45  2.91 mm, and from DPA were 0.72 
0.27 mm and 15.10  5.24 mm, respectively.
The detailed arterial supply of the second
lumbrical muscle is presented in Table 2 and dem-
onstrated in Fig. 3B.

Third lumbrical muscle

The third lumbrical muscle was bipennate in its

origin and begins from the adjacent tendons
(tendons to middle and ring finger) of FDP in all
specimens. The mean width and length of the
muscle were 6.19  1.15 mm (ranged from
4.14 mm to 8.58 mm) and 50  5.36 mm (ranged Figure 3 (A) The dominant (black arrow) and non-
from 38.71 mm to 66.39 mm), respectively. dominant arteries (white arrows) to the second lumbri-
The main arteries of this muscle were located cal muscle (II) of a right hand. First CPDA: first common
palmar digital artery, second CPDA: second palmar digi-
on its palmar surface and they originated from
tal artery, SPA: superficial palmar arch, and I: first
the second CPDA, SPA and/or the third CPDA. lumbrical muscle. (B) The proportions of the common
One to three dominant branches mostly entered arteries that give off either dominant or non-dominant
the muscle from its proximal third. Some single branches to the second lumbrical muscle. DPA: deep
or double non-dominant branches from the palmar arch, first CPDA: first common palmar digital artery,
second CPDA were entered to the distal third and SPA: superficial palmar arch.
of this muscle (Fig. 4A). Additional branches
from the DPA, and third and fourth PMCA were and 9.74  3.36 mm, and 0.73  0.18 mm and
observed. 11.74  3.84 mm, respectively.
The mean diameter and length of the dominant All branches to the third lumbrical muscle, their
branches from the second CPDA and SPA to the origins and entering parts are shown in Table 3 and
proximal third of the muscle were 0.68  0.12 mm demonstrated in Fig. 4B.

Table 2 The origins and entering zones of the arteries to the second lumbrical muscle
Second LM SPA First Second CB DPA Second Third
CPDA CPDA PMCA PMCA
Prox. third N 11 12 1 1 14 1 4
D/L (mm) 0.69/10.55 0.67/9.54 0.77/14.90 0.75/16.06 0.72/15.10 0.64/6.21 0.86/12.38
Mid. third N 33 3 2
D/L (mm) 0.67/8.45 0.64/22.25 0.65/5.37
Dist. third N 20 1
D/L (mm) 0.65/6.91 0.44/8.39
The total numbers (N) and mean diameters and lengths (D/L) are stated.
1124 O. Bilge et al.

FDP. The mean width and length of the muscle

were 5.28  1.00 mm (ranged from 3.73 mm to
7.85 mm) and 44.18  5.89 mm (ranged from
34.47 mm to 65.8 mm), respectively.
Unlike other lumbrical muscles, it has at least
two dominant arteries either on palmar and dorsal
surfaces originates from the third CPDA, fourth
PMCA and DPA. Furthermore, unlike other lumbr-
icals, one or two dominant arteries from the third
CPDA enter the distal third of the muscle in 17
hands (50%) (Fig. 5A).
The mean diameter and length of the dominant
branch from the third CPDA to the distal third of
the muscle were 0.75  0.18 mm and 7.54 
4.14 mm, respectively.
The mean diameter and length of the dominant
branches from the DPA and fourth PMCA to the
middle third of the muscle were 0.78  0.22 mm
and 16.18  5.46 mm, and 0.90  0.20 mm and
10.31  3.46 mm, respectively.
The detailed arterial supply of the fourth
lumbrical muscle is presented in Table 4 and
demonstrated in Fig. 5B.

Discussion

In ‘‘Kaplan’s Functional and Surgical Anatomy of

the Hand,’’11 the vascular anatomy of the lumbri-
Figure 4 (A) The arteries (arrows) to the third lumbri- cal muscles is taking place with a little additional
cal muscle from the second common palmar digital artery information to the original description of Salmon
(second CPDA) of a right hand. The dominant artery is and Dor.12
marked with white arrow and non-dominants with black
According to these textbooks, each lumbrical
arrows. III: Third lumbrical muscle, and third CPDA: third
muscle receives blood mainly from the DPA by
common palmar digital artery. (B) The proportions of the
common arteries that give off either dominant or non- a long lumbrical artery that enters the muscle from
dominant branches to the third lumbrical muscle. DPA: its dorsal surface. Lesser contribution from SPA
deep palmar arch, second CPDA: second common palmar and CPDA with small branches was found on the
digital artery, and SPA: superficial palmar arch. palmar surface.
Zbrodowski et al.13 focused on the SPA and its
Fourth lumbrical muscle contribution to the vascularization of the lumbri-
cal muscles without investigating the role of the
Like the third lumbrical muscle, this muscle was DPA. They found that most of the arteries to the
found to be bipennate in all specimens. It origi- lumbricals rose from the CPDA and a few direct
nated from the tendons to ring and little finger of branches from the SPA.

Table 3 The origins and entering zones of the arteries to the third lumbrical muscle
Third LM SPA First CPDA Second Third DPA Third Fourth
CPDA CPDA MCA MCA
Prox. N 12 2 12 5 10 3
third D/L (mm) 0.73/11.74 0.67/11.22 0.68/9.75 0.79/9.66 0.64/17.43 0.72/11.46
Mid. N 2 1 14 1 6 2 2
third D/L (mm) 0.75/10.25 0.66/10.62 0.65/8.70 1.32/8.03 0.65/15.03 1.33/12.54 0.69/9.43
Dist. N 4 20 1 1 1
third D/L (mm) 0.59/8.10 0.66/7.25 0.85/23.22 0.51/3.62 0.64/9.59
The total numbers (N) and mean diameters and lengths (D/L) were stated.
The vascular anatomy of the lumbrical muscles in the hand 1125

Our study revealed several previously reported

and unreported findings. We found that the lumbr-
ical muscles were supplied from both their palmar
and dorsal surfaces by both superficial and deep
palmar arches and/or their branches (CPDA and
PMCA). We also tried to describe the levels of entry
for the dominant arteries for each lumbrical
muscle and measured the size of the vessels and
muscles to guide surgical approaches.
In contrast to the classical anatomical textbooks,
we found that most of the dominant branches to the
lumbrical muscles originate from the SPA and/or its
common palmar digital branches.
The outcomes of our study determined that the
length and width of the lumbrical muscles were
reduced significantly from radial towards ulnar
sides. This is an important knowledge for flap
design. As reported previously, the first and second
lumbrical muscles are more appropriate than the
third and fourth lumbrical muscles. Not only the
size, but especially the vascular pattern of these
muscles allows design of a suitable pedicled island
flap. The dominant arteries to the radial lumbricals
are long and enter the proximal parts of the
muscles in general. Thus, they can be easily trans-
posed as proximally based island muscle flap.6
The width and length of the dominant arteries
to the first and second lumbrical muscles do not
show an evident difference from the arteries of
Figure 5 (A) A dominant artery (white arrow) from the the third and fourth lumbricals. However, the
third common palmar digital artery (third CPDA) to the
numbers and variety of origins and entering levels
distal third of the fourth lumbrical muscle (IV) of a left
of the dominant arteries to the ulnar lumbricals
hand. III: Third lumbrical muscle, second CPDA: second
common palmar digital artery, and SPA: superficial pal- are obvious. This variety is the major objection
mar arch. (B) The proportions of the common arteries to the usage of the ulnar lumbrical muscles in
that give off either dominant or non-dominant branches reconstructive surgery.
to the fourth lumbrical muscle. DPA: deep palmar arch A previously unreported finding in our study is
and third CPDA: third common palmar digital artery. the distal third level of entry of the dominant
artery to the fourth lumbrical muscle in 20 out of
Weinzweig et al.14 looked specifically to the vas- 34 hands. This information can be helpful for
cular suppliers of the lumbricals and interosseous planning a distally based island muscle flap.
muscles. They noted that the lumbrical muscles This anatomical study could guide some surgical
receive blood from SPA and DPA to the palmar approaches and reduce the deficiency about the
and dorsal surfaces in both axial and segmental vascular anatomical patterns of the lumbrical
way that shows appropriateness with our results. muscles in the literature.

Table 4 The origins and entering zones of the arteries to the fourth lumbrical muscle
Fourth LM Second CPDA Third CPDA DPA Third PMCA Fourth PMCA
Prox. third N 3 14 9 4 5
D/L (mm) 0.60/8.25 0.65/9.69 0.69/15.26 0.75/14.76 0.70/12.61
Mid. third N 6 13 7 6
D/L (mm) 0.63/8.59 0.64/8.01 0.78/16.18 0.90/10.32
Dist. third N 3 20 1 2
D/L (mm) 0.71/5.12 0.75/7.54 0.85/19.48 0.45/3.09
The total numbers (N) and mean diameters and lengths (D/L) are stated.
1126 O. Bilge et al.

8. Tark KC, Kim YW, Lee YH, et al. Replantation and revascu-
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