Venous drainage of the hand

Last revised by Craig Hacking on 8 Dec 2021

Venous drainage of the hand is predominantly via the dorsal venous network in the superficial fascia, which extends proximally across the dorsal aspect of the metacarpus to drain laterally into the cephalic vein, and medially into the basilic vein 1. An accessory cephalic vein commonly drains part of the central aspect of the dorsal venous network into the cephalic vein near the mid-forearm 2, though this vein may also arise from a number of more proximal locations 3.

The palmar venous drainage of the hand is insufficient; palmar digital veins drain primarily into the dorsal venous network, such that the increased pressure associated with a tight grip does not hinder venous return 1. In reality, movement of the digits milks the dorsal veins within their tight skin covering, promoting venous return 2.

Venous drainage of the hand may be divided into superficial and deep systems 2,4.

Superficial veins

  • dorsal venous network
    • major venous drainage of the hand
    • formed over the dorsal metacarpus, receiving blood from the dorsal metacarpal veins, in addition to some dorsal digital veins of the first and fourth digits, and the thumb 2
  • dorsal digital veins
    • drain the digits into the dorsal metacarpal veins (deep)
    • oblique intercapitular veins traverse between the metacarpal heads to drain palmar digital veins and the superficial palmar venous arch into their dorsal counterparts
  • superficial palmar venous plexus
    • located superficial to the palmar aponeurosis 2
    • partially drains the palmar digital veins into the superficial palmar venous arch

Deep veins

  • dorsal metacarpal veins
    • accompany the dorsal metacarpal arteries
    • receive perforating tributaries from the palmar metacarpal veins
    • terminate at the dorsal venous network and the radial veins
  • deep palmar venous arch
    • courses along the distal bases of the second to fifth metacarpals, receiving the palmar digital veins of the thumb, palmar metacarpal veins, and connecting veins from the superficial palmar venous arch
    • drains predominantly into the radial veins of the lateral forearm
  • superficial palmar venous arch
    • located deep to the palmar aponeurosis
    • supplied by the superficial palmar plexus and common palmar digital veins
    • drains partly to the median antebrachial vein, but mainly functions to shunt palmar blood towards the dorsum via oblique intercapitular veins

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