A PERSISTENT MEDIAN ARTERY AND BIFID MEDIAN NERVE IN THE SETTING OF CARPAL TUNNEL SYNDROME

2012 ◽  
Vol 15 (02) ◽  
pp. 1272004
Author(s):  
M. Lee Spangler ◽  
Emad Almusa ◽  
Cynthia Britton
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Imaging Features ◽  
Anatomic Variants ◽  
Tunnel Syndrome ◽  
Median Artery

We present a case of bifid median nerve and a persistent median artery presenting in the setting of carpal tunnel syndrome. The importance of these anatomic variants and their imaging features and workup are discussed.

scholarly journals Incidental finding of a persistent median artery (palmar type) during a routine carpal tunnel decompression: a case report

2017 ◽  
Vol 99 (7) ◽  
pp. e204-e205
Author(s):  
J Butt ◽  
AK Ahluwalia ◽  
A Dutta
Keyword(s):  
Case Report ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Incidental Finding ◽  
Surgical Decompression ◽  
Iatrogenic Injury ◽  
Palmar Fascia ◽  
Tunnel Syndrome ◽  
Median Artery

Carpal tunnel syndrome is characterised by compression of the median nerve. The mainstay of treatment is surgical decompression. This case report highlights the occurrence of a persistent median artery, which could complicate surgery. A 55-year-old woman underwent carpal tunnel decompression. An incidental finding of a large-calibre persistent median artery, which was superficial to the flexor sheath, could have been damaged. This was carefully retracted and the procedure was completed, without any complications. Several studies have shown the prevalence of persistent median artery to range from 1.1–27.1%. It is usually found deep to the flexor retinaculum but in this case it was found to be just beneath the palmar fascia. There is increased chance of iatrogenic injury with this particular variant. Surgeons performing the procedure should be mindful of this variation, because accidental damage could result in devastating consequences to the hand.

Student Section

1977 ◽  
Vol 44 (3) ◽  
pp. 144-144
Author(s):  
Rosemary Weiss
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Clinical Picture ◽  
Neutral Position ◽  
Wrist Movement ◽  
Tunnel Syndrome ◽  
Median Artery

A closer look at splinting for carpal tunnel syndrome (CTS) is necessary, since it is suggested that there are two types of CTS. 1) neural CTS, with a typical clinical picture of injury of the median nerve and, 2) vascular CTS where the early dominant symptoms are ischemic due to compression of a) a persisting median artery and, b) the radial and ulnar arteries Preventing wrist movement and excessive gripping during the day, alleviates compression of the radial, ulnar and possibly persisting median artery, and the median nerve. Thus, a release phenomenon does not occur at night. It is suggested that the wrist be splinted in a functional splint during the day, and a resting splint during the night, supporting the wrist in both cases, in a neutral position.

scholarly journals Carpal Tunnel Syndrome Secondary to Acute Thrombosis of Persistent Median Artery and Review of the Literature

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Antoine Lessard
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Upper Extremity ◽  
Carpal Tunnel ◽  
Anatomic Variation ◽  
Carpal Tunnel Release ◽  
Review Of The Literature ◽  
Acute Thrombosis ◽  
Tunnel Syndrome ◽  
Median Artery

Carpal tunnel syndrome (CTS) is the most common neuropathy of the upper extremity.1 We report a case in which a twenty-eight-year-old manual labourer presented with acute thrombosis in a persistent median artery which triggered acute carpal tunnel symptoms. A bifid median nerve was found upon carpal tunnel release. The knowledge of the existence of this anatomic variation is important in order to prevent inadvertent injury. We further discuss the possible aetiologies for CTS as well as neurovascular anomalies which may lead to median nerve compression at the wrist.

scholarly journals Persistent median artery carpal tunnel syndrome: a case series and literature review

2019 ◽  
Vol 2 (1) ◽  
pp. 93-98 ◽  
Author(s):  
Jake L Nowicki ◽  
Alexander Macgregor Cameron ◽  
Philip Griffin ◽  
Quoc Tai Khoa Lam ◽  
Nicholas Marshall
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Literature Review ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Case Series ◽  
Management Options ◽  
Tunnel Syndrome ◽  
Median Artery

Persistent median artery (PMA) thrombosis is a rare cause of carpal tunnel syndrome (CTS) with only a few cases reported in the literature. The bifid median nerve (BMN) is often associated with PMA and may be a factor in the development of CTS. There is a paucity of information in the literature on the management options for CTS secondary to PMA thrombosis. This paper presents two cases of CTS with associated PMA thrombosis and BMN and offers a discussion on diagnostic and management options.

Unusual Triad of Bifid Median Nerve, Persistent Median Artery, and Aberrant Muscle Causing Carpal Tunnel Syndrome

2020 ◽  
Vol 10 (3) ◽  
pp. e19.00468-e19.00468
Author(s):  
Anil Dhal ◽  
Saket Prakash ◽  
Pulkit Kalra ◽  
Yasim Khan
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Tunnel Syndrome ◽  
Median Artery ◽  
Aberrant Muscle

Bilateral Bifid Median Nerve with Bilateral Carpal Tunnel Syndrome: An Atypical Presentation, a Rare Cause and a Familiar Disease

2018 ◽  
Vol 23 (02) ◽  
pp. 274-277
Author(s):  
Anil K. Bhat ◽  
Ashwath M. Acharya ◽  
Jayakrishnan K. Narayana Kurup ◽  
Abhishek Chakraborti
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Clinical Examination ◽  
Carpal Tunnel ◽  
Atypical Presentation ◽  
Iatrogenic Injuries ◽  
Tunnel Syndrome ◽  
Median Artery ◽  
Bilateral Carpal Tunnel Syndrome

We report a case of bilateral carpal tunnel syndrome (CTS) with bilateral bifid median nerve (BMN) without a persistent median artery diagnosed by clinical examination, NCV and Ultrasonography. Bilateral BMN to produce bilateral CTS is extremely rare and is contrary to the popular classifications which state that BMN without persistent median artery or its anomalies will not produce CTS. Ultrasonogram is of additional help to identify such aberrations in the median nerve to prevent iatrogenic injuries during carpal tunnel decompression.

scholarly journals Carpal tunnel syndrome caused by the entrapment of a bifid Lanz IIIA Type anatomical variant of median nerve: A case report and systematic literature review

2021 ◽  
Vol 12 ◽  
pp. 37
Author(s):  
Emanuele La Corte ◽  
Clarissa A. E. Gelmi ◽  
Nicola Acciarri
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Anatomical Variant ◽  
Raising Awareness ◽  
Tunnel Syndrome ◽  
Median Artery

Background: Carpal tunnel syndrome (CTS) is the most common entrapment peripheral neuropathy. Median nerve may present several anatomical variations such as a high division or bifid median nerve (BMN). A thorough knowledge of the normal anatomy and variations of the median nerve at the wrist are fundamental to reduce complications during carpal tunnel release. Case Description: A 63-year-old man with CTS underwent preoperative ultrasound that showed the entrapment of the median nerve and disclosed a BMN Lanz IIIA Type anatomical variation at the carpal tunnel. During the surgery, the anatomical variant of a BMN at the wrist has been visualized. Both nervous rami entirely occupied the carpal canal and this may have predisposed to the development of the entrapment syndrome. Nor persistent median artery, or other associated abnormalities, have been identified. At the 6 months follow-up control, the patient referred a good surgical recovery with complete resolution of the preoperative symptoms of the median nerve entrapment. Conclusion: A rare case of Lanz IIIA BMN Type at the wrist has been encountered in a patient with a CTS and a systematic review and practical considerations have been presented with the aim of raising awareness to the neurosurgical community of a such rare variant that could be encountered during carpal tunnel release procedures. CTS may be caused by the entrapment of a BMN Lanz IIIA Type anatomical variant of median nerve. Preoperative US would help to identify such patients to reduce risk of iatrogenic injuries.

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