Fascia and Ligaments of the Hand

Palmar Structures

Palmar Aponeurosis

The palmar aponeurosis is a central thickening of deep fascia in the anterior palm. It has a triangular shape:

• Apex – attaches proximally to the flexor retinaculum and palmaris longus tendon.
• Base – divides distally into four slips (known as pretendinous bands), each sending:
  • Superficial band to the skin.
  • Deep band around the flexor tendons, fusing with the fibrous flexor sheath and deep transverse metacarpal ligaments.

Laterally, it is continuous with fascia covering the thenar and hypothenar muscles. It improves grip by anchoring the skin and protects the underlying tendons.

By TeachMeSeries Ltd (2025)

Fig 1
The fascia and ligaments of the palmar aspect of the hand.

Flexor Retinaculum

The flexor retinaculum is a band of deep fascia located on the anterior wrist. It forms the roof of the carpal tunnel, a fibro-osseous passageway that transmits the median nerve and the long flexor tendons of the forearm.

It extends from the scaphoid and trapezium laterally to the hook of hamate and pisiform medially. Its function is to hold the flexor tendons in place and protect the median nerve, preventing bowstringing during wrist flexion.

It is continuous proximally with the forearm fascia and distally with the palmar aponeurosis. For more detail, see Carpal Tunnel.

By TeachMeSeries Ltd (2025)

Fig 2
Transverse section of the carpal tunnel.

Superficial Transverse Palmar Ligament

The superficial transverse palmar ligament is a horizontal band that spans the distal portion of the palmar aponeurosis. Attaches to the distal slips (pretendinous bands) of the palmar aponeurosis and anchors the palmar skin.

This structure helps preserve the alignment of flexor tendons and contributes to an effective grip.

Superficial Transverse Metacarpal Ligament (Natatory Ligament)

The superficial transverse metacarpal ligament (Natatory ligament) is a fibrous band located at the distal palm. It connects the volar plates of the metacarpophalangeal joints – spanning transversely between adjacent metacarpal heads.

It plays a key role in maintaining transverse stability of the metacarpal arch and limits excessive finger abduction.

Palmar Carpal Ligament

The palmar carpal ligament is a transverse thickening of the antebrachial fascia that lies superficial and proximal to the flexor retinaculum on the anterior wrist.

It extends between the pisiform and the flexor carpi radialis tendon, forming the roof of Guyon’s canal.

It stabilises the ulnar nerve and artery within the canal and supports superficial structures at the wrist.

Dorsal Structures

Extensor Retinaculum

The extensor retinaculum is a fibrous band across the posterior wrist that secures the extensor tendons, preventing bowstringing during wrist extension.

Septae from its deep surface attach to the underlying radius, dividing the space beneath into six extensor compartments.

Dorsal Fascia

The dorsal fascia covers the dorsum of the hand and fingers, encapsulating and guiding the extensor tendons. It allows for frictionless tendon glide during finger extension.

By TeachMeSeries Ltd (2025)

Fig 3
Extensor retinaculum of the wrist

Digital Structures

The fingers are supported by specialised fascial structures that stabilise the skin and neurovascular bundles, and contribute to the coordination of digital movement.

• Cleland’s ligament – located on the dorsolateral side of the fingers, running just dorsal to the digital neurovascular bundles. It attaches proximally to the periosteum of the phalanges and distally to the dermis of the lateral skin. Its primary function is to stabilise the dorsal skin of the fingers and prevent it from moving excessively during flexion and extension.
• Grayson’s ligament – lies volarly on the lateral side of each finger, passing volar to the digital neurovascular bundles. It originates from the flexor tendon sheath and the volar periosteum, inserting into the lateral dermis of the digit. This ligament helps to stabilise the volar skin and limit the anterior displacement of neurovascular structures during finger movement.

These structures are part of the hand’s broader flexor and extensor mechanisms, which are explored in more detail elsewhere in TeachMeAnatomy