Surgical Excision of a Thrombosed Persistent Median Artery Causing Carpal Tunnel–Like Symptoms

Carpal tunnel syndrome (CTS) is a common peripheral neuropathy, caused by compression of the median nerve. Symptoms usually are present for months and aggravate over time. Acute onset of complaints and symptoms, like coldness of the hand, should raise awareness of a possible vascular cause of CTS.Persistent median artery (PMA) is a very rare anatomical variant of the blood supply of the upper limb. The presence of a thrombosed PMA is an extremely rare cause of CTS. In this article a case is presented in which the patient has carpal tunnel syndrome of his left hand, caused by a thrombosed persistent median artery. Conservative treatment, consisting of rest, ice applica- tion and non-steroidal anti-inflammatory drugs, failed. Surgical excision of the thrombosis and open exploration of the carpal tunnel was performed, with complete relief of symptoms. In literature different treatment options, like conservative treatment with antiplatelet therapy or surgical excision of the throm- bosis and decompression of the nerve, are described with good results. However up until now, no consensus exists about the golden standard in treatment of a thrombosed persistent median artery.

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

Journal of Musculoskeletal Research ◽

10.1142/s0218957712720049 ◽

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.

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Additional value of ultrasound in the assessment of carpal tunnel syndrome in rheumatological daily practice. A case of persistent median artery thrombosis

Joint Bone Spine ◽

10.1016/j.jbspin.2020.04.018 ◽

2020 ◽

Vol 87 (6) ◽

pp. 666-667 ◽

Cited By ~ 1

Author(s):

Gianluca Smerilli ◽

Jacopo Di Battista ◽

Edoardo Cipolletta ◽

Walter Grassi ◽

Emilio Filippucci

Keyword(s):

Carpal Tunnel Syndrome ◽

Carpal Tunnel ◽

Daily Practice ◽

Artery Thrombosis ◽

Tunnel Syndrome ◽

Median Artery ◽

Additional Value

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Sonographic Assessment of a Bifid Median Nerve and Median Artery in Carpal Tunnel Syndrome

The Journal of Rheumatology ◽

10.3899/jrheum.110036 ◽

2011 ◽

Vol 38 (8) ◽

pp. 1694-1696 ◽

Cited By ~ 1

Author(s):

ANGEL CHECA ◽

HUMAIRA HUSSAIN

Keyword(s):

Carpal Tunnel Syndrome ◽

Median Nerve ◽

Carpal Tunnel ◽

Sonographic Assessment ◽

Tunnel Syndrome ◽

Median Artery

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

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0088 ◽

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.

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