Anatomy of the ulnar artery as it relates to the transverse carpal ligament.

The anatomic relationship between the ulnar artery and transverse carpal ligament (TCL) as an aid in planning for minimally invasive carpal tunnel surgery was investigated. The anatomic course of the ulnar artery and its branches toward the TCL and the location of the median nerve were determined in 24 fresh cadaver hands perfused with a silicone compound. The ulnar artery coursed from 7 mm ulnar to 2 mm radial to the hook of hamate. The average distance between the superficial palmar arch and the distal margin of the TCL was 12 mm as measured along the flexor tendon of the ring finger. The location of the median nerve extended an average of 11 mm radial to the hook of hamate. A small arterial branch (average diameter, 0.7 mm) from the ulnar artery ran transversely just over the TCL in 6 of the 24 specimens. This branch was consistently located within 15 mm proximal to the TCL distal margin. These and other microscopic observations indicated that transecting the ligament at approximately 5 mm radial to the radial margin of the hook of hamate may minimize postoperative bleeding and avoid iatrogenic vascular and neural injury.