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Soft Tissue Anatomy

Hand soft tissue anatomy: extrinsic/intrinsic muscle balance, fascial planes, neurovascular relationships & common anatomical variations.

56 citationsUpdated Sep 2026
Illustration: Soft Tissue Anatomy

Overview

A clear understanding of acetabular osseous anatomy and surrounding soft tissues is essential for the evaluation and management of related pathologies [1]. This foundational knowledge extends to the upper extremity and hand, where specific anatomical details directly influence surgical planning. For instance, knowledge of the insertional anatomy of the triceps brachii tendon helps the surgeon optimize surgical approaches and triceps repair techniques [4]. Similarly, the cutaneous branch of the deep palmar artery, while presenting several anatomical variants, has a constant existence that makes it suitable for use as a pedicle for proximal hypothenar flaps [8]. The accessory flexor pollicis longus tendon is a common anatomical variant that challenges existing anatomical knowledge and presents potential clinical implications for surgeons [9].

The complexity of soft tissue structures in the hand requires precise anatomical awareness. Cleland's ligaments play an important role in maintaining skin stability in all positions of the finger, preventing skin bagging, protecting the neurovascular bundle, and creating a gliding path for the lateral slips of the extensor tendon [10]. Anatomic variations in the origin and disposition of the arteries to the second and fourth web spaces are associated with an atypical course posterior to the flexor tendons of the index and little fingers, respectively [12]. The lumbrical muscles exhibit a complex innervation pattern and peculiar anatomy of branching to different thirds of the muscle bellies, a feature that is important for dealing with complex and deep injuries in the palmar region [19]. Additionally, the fascia of the distal phalanx acts as a fibrous canopy, plays a role in prehension, and divides the digital pulp into proximal and distal components with distinct mobility and tethering mechanisms [40]. Findings regarding the surgical anatomy of the supraclavicular brachial plexus differ from standard illustrations and descriptions of the brachial plexus [23].

Beyond static anatomy, physiological differences and embryological origins inform clinical decision-making. The difference in muscle characteristics between the first dorsal interosseous and first lumbrical muscles should be considered when evaluating or treating contractures of the intrinsic muscles [30]. Atypical lipomas of the hand and forearm may have a more benign behavior than atypical lipomas of other anatomical sites [52]. An increased understanding of embryogenesis has advanced fundamental knowledge of limb anomalies, and evaluating physicians must possess a basic comprehension of embryogenesis and limb formation to comprehend congenital limb anomalies and communicate relevant knowledge to the family [55]. A proposed nomenclature for skeletal muscle injuries integrates topographic location with histoarchitectonic features of damage to connective tissue structures, a combined approach argued to be essential for accurate prognosis and understanding recurrence of skeletal muscle injuries [2].

Osseous Anatomy

The long axis of the third metacarpal penetrates the dorsal surface of the capitate about its midportion [36]. However, there is notable variation in the specific location where this penetration occurs [36]. Additionally, the angular relationships between the long axis of the third metacarpal and the dorsal surface of the capitate exhibit notable variation [36].

Ligaments and Joint Capsule

Finger and Thumb Ligaments

Cleland's ligaments serve a complex anatomical and functional role that extends beyond simple skin attachment. They prevent skin bagging, protect the neurovascular bundle, and create a gliding path for the lateral slips of the extensor tendon [10]. The volar plate exhibits volar elevation during active flexion [28]. This dynamic movement may generate stresses on adjacent ligaments while simultaneously contributing to joint stability and smooth gliding [28].

The scaphotrapezial ligament consists of three distinct fascicles, with the deep fascicle attaching 3.3 mm from the most distal point of the scaphoid [25]. In the thumb carpometacarpal joint, the estimated lengths of principal stabilizing ligaments change substantially during in vivo thumb motions [29]. Innervation patterns in the thumb trapeziometacarpal joint indicate a proprioceptive function in addition to biomechanical importance [51]. Specifically, the dorsal ligaments contain an abundance of nerve endings, whereas the anterior oblique ligament has little to no innervation [51]. Knowledge of the thumb sagittal band anatomy supports the repair of radial sagittal band injuries to prevent tendon instability [18].

Joint Capsule and Articular Structures

The anterior part of the extensor carpi radialis brevis origin is delicate because it is purely tendinous [46]. This region features a thin articular capsule attachment compared with the posterodistal attachment [46]. This structural vulnerability may be an initial factor leading to the development of lateral epicondylitis [46].

The dorsal triangular fibrocartilage of the metacarpophalangeal joint performs multiple protective and stabilizing functions. It may stabilize the extensor tendon, form a dorsal fossa, prevent extensor tendon attrition, and produce synovial fluid [47].

Surgical and Clinical Implications

The presence and function of the oblique retinacular ligament remain controversial [50]. Despite this uncertainty, surgery directed at recreating its presumed role continues to provide successful outcomes in the management of conditions such as swan-neck and mallet deformities [50].

Recent studies confirm Littler's previously depicted anatomic consistency regarding the A1 pulley [15]. This consistency is reassuring for surgical procedures based on this anatomy [15]. During open release, anatomic knowledge of the course of the superficial radial nerve and its branches is important for avoiding nerve injury [7]. Although the extensor tendon-reflecting technique revealed the greatest amount of surface, nearly 50% of the proximal phalanx articular surface remained inaccessible as long as the collateral ligaments were intact [13].

Muscles and Tendons

General Principles

Accurate prognosis and understanding of recurrence in skeletal muscle injuries require a nomenclature that integrates topographic location with the histoarchitectonic features of damage to connective tissue structures [2].

Upper Extremity

The deep branch of the ulnar nerve follows a specific course with a precise branching pattern and distribution [14]. The vertical distance from the pisoscaphoid line to the crossing points with metacarpals for this nerve is approximately 4 cm [14]. Muscular branches of the deep branch of the ulnar nerve present in two distinct types: trunks that innervate multiple muscles and separate branches that innervate single muscles [14]. Surface markers derived from skin creases allow for accurate localization of the underlying pulley and tendon system, facilitating the planning of limited incisions [16]. Regarding the adductor pollicis, the dorsal part of the intramuscular tendon inserts into both the aponeurosis and the joint capsule [63].

Flexor Tendon System

The flexor tendon pulley possesses a complex shape rather than a simple semicircular form, owing to a middle layer that runs partially dorsally and partially ventrally under the flexor tendons in a figure-of-8 configuration [31]. Anatomical findings regarding the insertion of the flexor digitorum profundus (FDP) aid in the anatomical attachment of the FDP tendon during the treatment of zone I injuries [6]. However, commonly available suture anchors and drill bits are suboptimal for anchoring the FDP tendon to the distal phalanx of the little finger [62]. Specifically, standard drill bits are too long for this application and may penetrate the far cortex [62].

Joint Anatomy and Ligaments

Findings on the innervation of the proximal interphalangeal joint provide an anatomical basis for procedures designed to denervate the PIP joint [5].

Neurovascular Anatomy

Nerve Anatomy and Course

The deep branch of the ulnar nerve provides muscular innervation through two distinct types of branches: trunks that innervate multiple muscles and separate branches that innervate single muscles [14]. Regarding the abductor digiti minimi muscle, a single branch is present in 22 of 30 specimens [27]. Rare variations in the innervation of this muscle include dual and triple branch innervation [27]. In the lower extremity, the distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal at the posterior tip of the fibula [48].

Vascular Anatomy and Supply

The cutaneous branch of the deep palmar artery presents several anatomical variants but has constant existence, making it suitable for use as a pedicle for proximal hypothenar flaps [8]. A nutrient vessel is often the only vessel supplying the head of the proximal phalanx, making this area particularly susceptible to vascular compromise [35].

Neurovascular Bundle and Variations

Surgeons should identify and dissect the neurovascular bundle proximally and distally throughout its course to prevent injury in Dupuytren’s disease [11]. Anomalous muscles in the forearm can help explain various conditions of arterial and nerve dysfunctions which otherwise are thought to be idiopathic [24].

Surgical Implications and Outcomes

The dorsal nerve fascial island flap restores sensory function without damaging main nerves or blood vessels, making it an optimal option for finger soft tissue defects at the distal segments [3]. There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap [49]. Findings on the motor branch to the fourth lumbrical provide a guide for intraoperative localization of the 4L/3PI motor branch and may explain findings seen after distal nerve transfers [44].

Biomechanics and Function

General Principles

Controlled motion during early healing acts as a form of controlled stress that can be harnessed to generate appropriate reparative tissues [20]. The microvacuolar system fills the spaces between the tendon and the skin, providing tissue continuity and acting as a shock-absorbing system. This system permits gliding without translation of the skin while providing a framework for blood vessels, nerves, and lymphatics [58]. Understanding hand therapy treatment techniques requires biomechanical concepts such as stress, strain, and moments [54].

Tendon and Pulley Mechanics

The flexor tendon pulley system does not have a semicircular shape but a much more complicated one, owing to its middle layer which in part runs dorsally and in part ventrally, under the flexor tendons like a figure-of-8 [31]. The suture loop holding capacity of the flexor digitorum profundus tendon varies within and outside the digital tendon sheath due to variations in the structural properties of the flexor tendon in different sections [21].

Joint Stability and Ligament Dynamics

Volar elevation of the volar plate seen in active flexion could provide dynamic stresses on the adjacent ligaments and contribute to the stability and smooth gliding of the proximal interphalangeal joint [28]. The volar plate of the proximal interphalangeal joint exhibits three sequential phases of motion: sliding, elevating, and rolling in the recess [56].

Muscle Function and Tissue Properties

The difference in the muscle characteristics between the first dorsal interosseous and first lumbrical muscles should be considered when evaluating or treating contractures of the intrinsic muscles [30]. A force of 0.980 N applied to the lumbrical muscle is ideal for maximum finger trajectory and metacarpophalangeal joint balancing [60]. Extending the ulnar fingers during pinching enhances the activity of key muscles involved in the movement and allows for more rapid force exertion [57]. The longitudinal extensibility of the dorsal skin of the hand generally increased from distal to proximal and from ulnar to radial [53]. The change in curvature of the digital artery during 30–90 degrees of flexion is lower in middle-aged individuals than in young individuals [59].

Surgical and Clinical Considerations

The dorsal nerve fascial island flap technique restores sensory function without damaging main nerves or blood vessels, making it an optimal option for finger soft tissue defects at the distal segments [3]. Safe limits for the application time and surface pressures of digital tourniquets are difficult to define, and the 'one size fits all' philosophy is questioned [61]. Nerve repair and reconstruction principles include minimizing tension, careful soft-tissue handling, and treatment options for nerve defects such as autograft, nerve conduit, and decellular allograft [17].

Common Sites of Injury

Accurate prognosis and understanding of recurrence in skeletal muscle injury require a nomenclature that integrates topographic location with the histoarchitectonic features of damage to connective tissue structures [2]. Specific anatomical knowledge directly informs surgical planning and repair techniques across various regions. Knowledge of the insertional anatomy of the triceps brachii tendon helps surgeons optimize surgical approaches and triceps repair techniques [4]. Similarly, understanding the functional anatomy of the thumb sagittal band supports repair of radial sagittal band injuries to prevent tendon instability [18].

In the hand and digits, detailed anatomical findings guide both reconstructive and denervation procedures. Anatomical findings regarding the innervation of the proximal interphalangeal joint provide a basis for procedures to denervate the PIP joint [5]. The complex innervation pattern and peculiar anatomy of branching to different thirds of the lumbrical muscle bellies are important for dealing with complex and deep injuries in the palmar region [19]. For tendon repairs, anatomical findings regarding the flexor digitorum profundus insertion may aid anatomical attachment of the FDP tendon in the treatment of zone I injuries [6]. Variations in the structural properties of the flexor tendon in different sections are attributed to differences in suture loop holding capacity within and outside the digital tendon sheath [21].

Soft tissue stability and protection rely on specific ligamentous and fascial structures. Cleland's ligaments play an important role in maintaining skin stability in all positions of the finger, preventing skin bagging, protecting the neurovascular bundle, and creating a gliding path for the lateral slips of the extensor tendon [10]. Dorsal nerve fascial island flaps restore sensory function without damaging main nerves or blood vessels, making them an optimal option for finger soft tissue defects at the distal segments [3].

Pathological findings in specific injury mechanisms and conditions include the presence of tendon adhesions in the majority of trigger fingers [33]. Regarding traumatic lacerations, nerve damage was greatest in table saw lacerations [32].

Surgical Anatomy

Upper Extremity

The axillary artery travels an average of 1-1.8 cm from the inferior glenoid margin, placing the vessel at significant risk [45]. In the forearm, anomalous muscles should be considered as they may explain various conditions of arterial and nerve dysfunctions that are otherwise thought to be idiopathic [24]. Regarding the hand, the cutaneous branch of the deep palmar artery presents several anatomical variants but has a constant existence that makes it suitable for use as a pedicle for proximal hypothenar flaps [8].

Hand and Fingers

Recent studies confirm Littler's previously depicted anatomic consistency regarding the A1 pulley, which is reassuring for surgical procedures based on this consistency [15]. For zone I injuries, specific findings may aid the anatomical attachment of the flexor digitorum profundus tendon [6]. Additionally, these findings provide an anatomical basis for procedures to denervate the proximal interphalangeal joint [5]. When performing a homodigital dorsal adipofascial reverse flap, a minimum 10 mm cuff of tissue proximal to the eponychial fold is recommended for safe dissection, challenging the previously proposed 5 mm safety distance [43].

Soft Tissue Pathology

To minimize recurrence, the authors recommend removing the entire epidermoid cyst tumour with a careful marginal excision that includes overlying scar tissue from any previous penetrating injury [34].

Key Evidence

  • [L5] The authors propose a nomenclature for skeletal muscle injuries that integrates topographic location with histoarchitectonic features of the damage to connective tissue structures, arguing that this combined approach is essential for accurate prognosis and understanding recurrence. [2] (10.1177/2325967120909090)
  • [L4] The technique restores sensory function without damaging main nerves or blood vessels, making it an optimal option for finger soft tissue defects at the distal segments. [3] (10.1186/s13018-022-03309-9)
  • [L5] Knowledge of this anatomy will help the surgeon optimize surgical approaches and triceps repair techniques. [4] (10.1016/j.jse.2009.10.008)
  • [L5] These findings provide an anatomical basis for procedures to denervate the PIP joint. [5] (10.1016/j.jhsa.2018.07.014)
  • [L5] These findings may aid anatomical attachment of the FDP tendon in the treatment of zone I injuries. [6] (10.1016/j.jhsa.2014.11.004)
  • [L5] Anatomic knowledge of the course of the superficial radial nerve and its branches is important during open release for avoiding nerve injury. [7] (10.1016/j.jhsa.2013.12.004)
  • [L5] Although it presents several anatomical variants, its constant existence makes it suitable for use as a pedicle for proximal hypothenar flaps. [8] (10.1177/1558944719895785)
  • [L4] The accessory FPL tendon is a common anatomical variant that challenges existing anatomical knowledge and presents potential clinical implications for surgeons. [9] (10.1177/17531934251347077)
  • [L4] The anatomy and function of Cleland's ligaments is more complex than previously described, and they play an important role in maintaining skin stability in all positions of the finger, preventing skin bagging, protecting the neurovascular bundle, and creating a gliding path for the lateral slips of the extensor tendon. [10] (10.1177/1753193413511944)
  • [L4] Surgeons should identify and dissect the neurovascular bundle proximally and distally throughout its course to prevent injury. [11] (10.1177/1753193409349855)
  • [L4] Anatomic variations in the origin and disposition of the arteries to the second and fourth web spaces are associated with an atypical course posterior to the flexor tendons of the index and little fingers, respectively. [12] (10.1177/1753193418764289)
  • [L5] Although the extensor tendon-reflecting technique revealed the greatest amount of surface, nearly 50% of the proximal phalanx articular surface remained inaccessible as long as the collateral ligaments were intact. [13] (10.1016/j.jhsa.2014.02.004)
  • [L5] The study provides a clear description of the course, precise branching pattern, and distribution of the deep branch of the ulnar nerve, noting that the vertical distance from the pisoscaphoid line to the crossing points with metacarpals is about 4 cm and identifying two types of muscular branches: trunks innervating multiple muscles and separate branches innervating single muscles. [14] (10.1177/1753193415622188)
  • [L5] Recent studies confirm Littler's previously depicted anatomic consistency regarding the A1 pulley, which is reassuring for surgical procedures based on this consistency. [15] (10.1016/j.jhsa.2011.03.047)
  • [L5] Skin creases can be used as surface markers to accurately locate the underlying pulley and tendon system and plan for limited incisions. [16] (10.1016/j.jhsa.2011.12.036)
  • [L5] Knowledge of this anatomy supports repair of radial SB injuries to prevent tendon instability. [18] (10.1016/j.jhsa.2008.01.039)
  • [L5] The study highlights the complex innervation pattern and peculiar anatomy of branching to different thirds of the lumbrical muscle bellies, which are important for dealing with complex and deep injuries in the palmar region. [19] (10.1177/1558944720963881)
  • [L5] Controlled motion during early healing is a form of controlled stress and can be harnessed to generate appropriate reparative tissues. [20] (10.1016/j.jht.2022.12.003)
  • [L5] This difference is attributed to variations in the structural properties of the flexor tendon in different sections. [21] (10.1177/1753193412474175)
  • [L5] These findings differ from the standard illustrations and descriptions of the brachial plexus. [23] (10.2106/jbjs.n.00706)
  • [L4] These variations should also be kept in mind as they could help explain various conditions of arterial and nerve dysfunctions which otherwise are thought to be idiopathic. [24] (10.1007/s11552-007-9033-7)
  • [L5] The scaphotrapezial ligament consists of three distinct fascicles, including a deep fascicle that attaches 3.3 mm from the most distal point of the scaphoid. [25] (10.1016/j.jhsa.2025.09.010)
  • [L4] The study identified three main innervation patterns of the abductor digiti minimi muscle, with a single branch present in 22 of 30 specimens, and documented rare variations including dual and triple branch innervation. [27] (10.1054/jhsb.2002.0784)
  • [L4] Volar elevation of the volar plate seen in active flexion could provide dynamic stresses on the adjacent ligaments and contribute to the stability and smooth gliding of the joint. [28] (10.1016/j.jhsa.2012.03.004)
  • [L4] The estimated lengths of principal ligaments stabilizing the CMC joint change substantially during thumb motions in vivo. [29] (10.1016/j.jhsa.2010.11.007)
  • [L4] The difference in the muscle characteristics between the FDI and FL muscles should be considered when evaluating or treating contractures of the intrinsic muscles. [30] (10.1016/j.jhsa.2019.01.016)
  • [L5] The pulley does not have a semicircular shape but a much more complicated one, owing to its middle layer which in part runs dorsally and in part ventrally, under the flexor tendons like a figure-of-8. [31] (10.1054/jhsb.1999.0341)
  • [L5] Nerve damage was greatest in table saw lacerations. [32] (10.1016/j.jhsg.2025.100833)
  • [L2] Tendon adhesions are present in the majority of trigger fingers. [33] (10.1177/1753193420969293)
  • [L4] The authors recommend removing the entire tumour with a careful marginal excision that includes overlying scar tissue from any previous penetrating injury to minimize recurrence. [34] (10.1177/1753193409347509)
  • [L5] This nutrient vessel is often the only vessel supplying the head of the proximal phalanx, making this area particularly susceptible to vascular compromise. [35] (10.1016/j.jhsa.2022.09.014)
  • [L4] The long axis of the MC3 penetrates the dorsal surface of the capitate about its midportion, but there is notable variation in this location as well as in the angular relationships. [36] (10.1016/j.jhsa.2024.07.008)
  • [L5] The paper describes the detailed anatomy of the distal phalanx fascia and its role in prehension, noting that the fascia acts as a fibrous canopy and that the digital pulp is divided into proximal and distal components with distinct mobility and tethering mechanisms. [40] (10.2106/00004623-197557060-00009)
  • [L5] It recommends a minimum 10 mm cuff of tissue proximal to the eponychial fold for safe dissection, challenging the previously proposed 5 mm safety distance. [43] (10.1177/1753193409360955)
  • [L5] These findings provide a guide for intraoperative localization of the 4L/3PI motor branch and may explain findings seen after distal nerve transfers. [44] (10.1016/j.jhsa.2024.11.023)
  • [L5] The axillary artery travels an average of 1-1.8 cm from the inferior glenoid margin, which puts the artery at significant risk. [45] (10.1016/j.jse.2020.09.018)
  • [L5] The anterior part of the ECRB origin was delicate because it was purely tendinous and had a thin articular capsule attachment compared with the posterodistal attachment; this thin attachment could be an initial factor leading to the development of lateral epicondylitis. [46] (10.1016/j.jhsa.2013.11.036)
  • [L5] Possible functions include stabilization of the extensor tendon, formation of a dorsal fossa, prevention of extensor tendon attrition, and synovial fluid production. [47] (10.1016/j.jhsa.2015.03.019)
  • [L5] This cadaveric study shows that the distance from the peroneal tendons sheath to the sural nerve decreases from proximal to distal. [48] (10.1007/s00167-019-05438-x)
  • [L3] There are no differences at 2 years in postoperative clinical outcomes when dorsal digital nerves are used to reconstruct flap sensation regardless of preservation of the dorsal branches of the proper digital nerves in the first dorsal metacarpal artery flap. [49] (10.1186/s13018-021-02838-z)
  • [L5] The presence and function of the oblique retinacular ligament are controversial, but surgery directed at recreating its presumed role continues to provide successful outcomes in the management of conditions such as swan-neck and mallet deformities. [50] (10.1016/j.jhsa.2013.12.011)
  • [L5] The thumb trapeziometacarpal joint ligaments had an abundance of nerve endings in the dorsal ligaments but little to no innervation in the anterior oblique ligament, inferring a proprioceptive function of these ligaments in addition to their biomechanical importance. [51] (10.1016/j.jhsa.2011.12.038)
  • [L4] The results of the current series and a review of the literature suggest that atypical lipomas of the hand and forearm may have a more benign behavior than atypical lipomas of other anatomical sites. [52] (10.1016/j.jhsa.2015.12.032)
  • [L4] Generally, the extensibility increased from distal to proximal and from ulnar to radial. [53] (10.1177/1753193419864881)
  • [Paper] This introductory article lays the foundation of biomechanical concepts such as stress, strain, and moments, which are necessary for understanding the basic science underlying hand therapy treatment techniques. [54] (10.1016/j.jht.2011.12.006)
  • [L5] An increased understanding of embryogenesis has advanced fundamental knowledge of limb anomalies, and evaluating physicians must possess a basic comprehension of embryogenesis and limb formation to comprehend congenital limb anomalies and communicate relevant knowledge to the family. [55] (10.1016/j.jhsa.2009.06.013)
  • [L4] The authors propose three sequential phases of volar plate motion: sliding, elevating, and rolling in the recess. [56] (10.1016/j.jhsa.2010.10.034)
  • [L4] Extending the ulnar fingers during pinching enhances the activity of key muscles involved in the movement and allows for more rapid force exertion. [57] (10.1177/17531934231211254)
  • [L5] The microvacuolar system fills the spaces between the tendon and the skin, providing tissue continuity, acting as a shock absorbing system, and permitting gliding without translation of the skin while providing a framework for blood vessels, nerves and lymphatics. [58] (10.1177/1753193410374412)
  • [L4] The change in curvature during 30–90 degrees of flexion is lower in middle-aged individuals than in young individuals. [59] (10.1177/1753193418807833)
  • [L5] A force of 0.980 N applied to the lumbrical muscle is ideal for maximum finger trajectory and MP joint balancing. [60] (10.1177/1753193415597113)
  • [L5] Safe limits for application time and surface pressures are difficult to define, and the 'one size fits all' philosophy is questioned. [61] (10.1177/1753193413492059)
  • [L5] The commonly available suture anchors and drill bits are suboptimal for anchoring the flexor digitorum profundus tendon to the distal phalanx of the little finger, as the drill bits are too long and may penetrate the far cortex. [62] (10.1177/1753193411419595)
  • [L5] The dorsal part of the intramuscular tendon of the adductor pollicis inserts into not only the aponeurosis but also the joint capsule. [63] (10.1016/j.jhsa.2017.12.009)

References

[1] Chapter 33 Evaluation and Management of Acetabular Fractures. 2021.

[2] A Histoarchitectural Approach to Skeletal Muscle Injury: Searching for a Common Nomenclature. Orthopaedic Journal of Sports Medicine. 2020. DOI: 10.1177/2325967120909090

[3] Effect of dorsal nerve fascial island flap on repairing distal soft tissue defects at the proximal segment of the index, middle, ring, and little fingers. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03309-9

[4] Insertional anatomy of the triceps brachii tendon. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.10.008

[5] Innervation of the Proximal Interphalangeal Joint: An Anatomical Study. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2018.07.014

[6] Anatomy of the Flexor Digitorum Profundus Insertion. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.11.004

[7] The Relationship of the Superficial Radial Nerve and Its Branch to the Thumb to the First Extensor Compartment. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.12.004

[8] The Cutaneous Branch of the Deep Palmar Artery and Blood Supply to the Proximal Hypothenar Skin: An Anatomic Research Oriented to Flap Design. HAND. 2020. DOI: 10.1177/1558944719895785

[9] Accessory flexor pollicis longus tendon – a clinical and cadaveric study. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251347077

[10] The anatomy and function of Cleland’s ligaments. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413511944

[11] Spiralling of the neurovascular bundle in Dupuytren’s disease. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409349855

[12] Variations in the origins and absence of the common digital arteries of the hand: a cadaveric study. Journal of Hand Surgery (European Volume). 2018. DOI: 10.1177/1753193418764289

[13] Dorsal Surgical Approaches to the Proximal Interphalangeal Joint: A Comparative Anatomic Study. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.004

[14] Anatomy of the deep branch of the ulnar nerve. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415622188

[15] Anatomical Study of the A1 Pulley: Length and Location by Means of Cutaneous Landmarks on the Palmar Surface. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2011.03.047

[16] Surface Markers for Locating the Pulleys and Flexor Tendon Anatomy in the Palm and Fingers With Reference to Minimally Invasive Incisions. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.12.036

[17] Chapter 30 Management of Traumatic Nerve Injuries in the Upper Extremity. 2021.

[18] Functional Anatomy of the Thumb Sagittal Band. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.01.039

[19] Lumbrical Muscles Neural Branching Patterns: A Cadaveric Study With Potential Clinical Implications. HAND. 2020. DOI: 10.1177/1558944720963881

[20] How controlled motion alters the biophysical properties of musculoskeletal tissue architecture. Journal of Hand Therapy. 2023. DOI: 10.1016/j.jht.2022.12.003

[21] The suture loop holding capacity of flexor digitorum profundus tendon within and outside the digital tendon sheath. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193412474175

[23] Surgical Anatomy of the Supraclavicular Brachial Plexus. Journal of Bone and Joint Surgery. 2015. DOI: 10.2106/jbjs.n.00706

[24] The Concomitant Presence of Two Anomalous Muscles in the Forearm. HAND. 2007. DOI: 10.1007/s11552-007-9033-7

[25] Anatomy of the Scaphotrapezial Ligament Complex and its Implications for Distal Scaphoid Resection. The Journal of Hand Surgery. 2026. DOI: 10.1016/j.jhsa.2025.09.010

[27] Innervation Pattern of the Abductor Digiti Minimi Muscle of the Hand. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2002.0784

[28] Biomechanical Differences of the Proximal Interphalangeal Joint Volar Plate During Active and Passive Motion: A Dynamic Ultrasonographic Study. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.03.004

[29] In Vivo Length and Changes of Ligaments Stabilizing the Thumb Carpometacarpal Joint. The Journal of Hand Surgery. 2011. DOI: 10.1016/j.jhsa.2010.11.007

[30] Assessment of the Passive Tension of the First Dorsal Interosseous and First Lumbrical Muscles Using Shear Wave Elastography. The Journal of Hand Surgery. 2019. DOI: 10.1016/j.jhsa.2019.01.016

[31] Histogenesis and Morphology of the Flexor Tendon Pulley System in the Human Embryonic Hand. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0341

[32] More Than Epineurium Deep: Characterizing Peripheral Nerve Damage Using High-Resolution Micro-Computed Tomography for Simulated Peripheral Nerve Lacerations. Journal of Hand Surgery Global Online. 2025. DOI: 10.1016/j.jhsg.2025.100833

[33] Adhesions as a component of the trigger finger: a dynamic sonographic study. Journal of Hand Surgery (European Volume). 2020. DOI: 10.1177/1753193420969293

[34] Epidermoid cysts in the hand. Journal of Hand Surgery (European Volume). 2009. DOI: 10.1177/1753193409347509

[35] Arterial Perfusion of the Proximal Phalanx Revisited: New Insights Based on Micro-Computed Tomography. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2022.09.014

[36] The Three-Dimensional Relationship of the Axes of the Capitate and Third Metacarpal. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.07.008

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[43] Homodigital dorsal adipofascial reverse flap: anatomical study of distal perforators and key points for safe dissection. Journal of Hand Surgery (European Volume). 2010. DOI: 10.1177/1753193409360955

[44] Anatomical Characterization of the Motor Branch to the Fourth Lumbrical: A Cadaver Study. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.11.023

[45] Surgical anatomy of the axillary artery: clinical implications for open shoulder surgery. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.09.018

[46] Joint Capsule Attachment to the Extensor Carpi Radialis Brevis Origin: An Anatomical Study With Possible Implications Regarding the Etiology of Lateral Epicondylitis. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2013.11.036

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[51] Innervation Patterns of Thumb Trapeziometacarpal Joint Ligaments. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2011.12.038

[52] Conventional and Cellular Atypical Lipomas of the Hand and Forearm: A Report of 9 Cases. The Journal of Hand Surgery. 2016. DOI: 10.1016/j.jhsa.2015.12.032

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