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.

Palmaris profundus in the carpal tunnel

2021 ◽  
Vol 14 (8) ◽  
pp. e241328
Author(s):  
Theodore Paul Pezas ◽  
Rajive Jose
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Anatomical Variant ◽  
Longus Tendon ◽  
Raising Awareness ◽  
Tunnel Syndrome ◽  
Palmaris Longus Tendon ◽  
Secondary Causes

Carpal tunnel release is a routinely performed operation to relieve pressure caused by compression on the median nerve. In the majority of cases, the causation of the compression will be idiopathic. Among the secondary causes of median nerve compression is the palmaris profundus, a rare anatomical variant separate to the palmaris longus tendon. It has been suggested that it may cause carpal tunnel syndrome as it courses underneath the flexor retinaculum with the contents of the carpal tunnel reducing the space available to the median nerve. Several cases have found it intimately associated with the median nerve within the carpal tunnel. Raising awareness of this anatomical variant is therefore important for those undertaking carpal tunnel decompression in order to avoid unintended damage.

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 Anatomical variation of the median nerve and its thenar branch: Clinical and surgical application in the treatment of carpal tunnel syndrome

2021 ◽  
Vol 09 (03) ◽  
pp. 326-329
Author(s):  
Charaf eddine Elkassimi ◽  
Mustapha Fadili ◽  
Sami Rouadi ◽  
Abdelhak Garch
Keyword(s):  
Surgical Treatment ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Anatomical Variation ◽  
Anatomical Variations ◽  
Annular Ligament ◽  
Surgical Application ◽  
Tunnel Syndrome ◽  
Open Surgical Treatment

Carpal tunnel syndrome is the most common root canal pathology. The surgical treatment corresponds to a release of the median nerve by incision of the anterior annular ligament of the carpus by open surgical treatment or endoscopy. Knowledge of the normal anatomy and anatomical variations of the median nerve at the wrist is fundamental to avoiding complications in median nerve release in the treatment of carpal tunnel syndrome. Through this work we will show the interest of knowledge of the anatomy of the median nerve as well as its anatomical variations in order to derive the main clinical applications and to avoid the risks associated with open or endoscopic surgery in the treatment of carpal tunnel syndrome.

Systematic review and meta-analysis of surgical options for recurrent or persistent carpal tunnel syndrome: simple decompression versus coverage of the median nerve

2021 ◽  
pp. 175319342110017
Author(s):  
Saskia F. de Roo ◽  
Philippe N. Sprangers ◽  
Erik T. Walbeehm ◽  
Brigitte van der Heijden
Keyword(s):  
Systematic Review ◽  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Meta Analysis ◽  
Surgical Techniques ◽  
Open Release ◽  
Flap Coverage ◽  
Tunnel Syndrome

We performed a systematic review on the success of different surgical techniques for the management of recurrent and persistent carpal tunnel syndrome. Twenty studies met the inclusion criteria and were grouped by the type of revision carpal tunnel release, which were simple open release, open release with flap coverage or open release with implant coverage. Meta-analysis showed no difference, and pooled success proportions were 0.89, 0.89 and 0.85 for simple open carpal tunnel release, additional flap coverage and implant groups, respectively. No added value for coverage of the nerve was seen. Our review indicates that simple carpal tunnel release without additional coverage of the median nerve seems preferable as it is less invasive and without additional donor site morbidity. We found that the included studies were of low quality with moderate risk of bias and did not differentiate between persistent and recurrent carpal tunnel syndrome.

scholarly journals Bifid Median Nerve in the Bulgarian Population: An Anatomical and Clinical Study

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Georgi P. Georgiev ◽  
Svetoslav A. Slavchev ◽  
Iva N. Dimitrova ◽  
Boycho Landzhov
Keyword(s):  
Clinical Study ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Anatomical Variation ◽  
Clinical Implications ◽  
Upper Limbs ◽  
Anatomical Variant ◽  
Human Cadavers ◽  
Tunnel Syndrome ◽  
Bulgarian Population

High division of the median nerve proximal to the carpal tunnel, also known as a bifid median nerve, is a rare anatomical variant with an incidence between 1 and 3%. In order to study the incidence of this anatomical variation in the Bulgarian population, we examined the upper limbs of 51 formol-carbol fixed human cadavers and also 154 upper limbs undergoing carpal tunnel decompression. We detected one case of bifid median nerve during anatomical dissections and two cases in patients with carpal tunnel syndrome. In one of the clinical cases, the anatomical variation was detected preoperatively by MRI. We discuss different variations of this nerve and emphasize their potential clinical implications.

scholarly journals Thrombosis of persistent median artery as a cause of carpal tunnel syndrome : case report

2021 ◽  
Vol 87 (3) ◽  
pp. 529-532
Author(s):  
S Arnauw ◽  
G De Wachter
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Conservative Treatment ◽  
Carpal Tunnel ◽  
Treatment Options ◽  
Surgical Excision ◽  
Acute Onset ◽  
Complete Relief ◽  
Anatomical Variant ◽  
Tunnel Syndrome ◽  
Median Artery

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.

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 Ultrasonography Findings in Severe Carpal Tunnel Syndrome

Hand ◽  
2018 ◽  
Vol 15 (1) ◽  
pp. 64-68
Author(s):  
Gideon Nkrumah ◽  
Alan R. Blackburn ◽  
Robert J. Goitz ◽  
John R. Fowler
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Carpal Tunnel Release ◽  
Nerve Conduction Studies ◽  
Cross Sectional ◽  
Younger Patients ◽  
Tunnel Syndrome ◽  
Sensory Latency ◽  
Pisiform Bone

Background: Increasing severity of carpal tunnel syndrome (CTS), as graded by nerve conduction studies (NCS), has been demonstrated to predict the speed and completeness of recovery after carpal tunnel release (CTR). The purpose of this study is to compare the cross-sectional area (CSA) of the median nerve in patients with severe and nonsevere CTS as defined by NCS. Methods: Ultrasound CSA measurements were taken at the carpal tunnel inlet at the level of the pisiform bone by a hand fellowship–trained orthopedic surgeon. Severe CTS on NCS was defined as no response for the distal motor latency (DML) and/or distal sensory latency (DSL). Results: A total of 274 wrists were enrolled in the study. The median age was 51 years (range: 18-90 years), and 72.6% of wrists were from female patients. CSA of median nerve and age were comparatively the best predictors of severity using a linear regression model and receiver operator curves. Using cutoff of 12 mm2 for severe CTS, the sensitivity and specificity are 37.5% and 81.9%, respectively. Conclusions: Ultrasound can be used to grade severity in younger patients (<65 years) with a CTS-6 score of >12.

scholarly journals Median Nerve Variation: A Complete Spin before Terminal Branching

2020 ◽  
Vol 15 (01) ◽  
pp. e1-e4
Author(s):  
Amgad S. Hanna ◽  
Zhikui Wei ◽  
Barbara A. Hanna
Keyword(s):  
Carpal Tunnel Syndrome ◽  
Median Nerve ◽  
Carpal Tunnel ◽  
Distal Forearm ◽  
Flexor Digitorum Superficialis ◽  
Anatomical Variant ◽  
Motor Branch ◽  
Surgical Interventions ◽  
Tunnel Syndrome ◽  
Flexor Digitorum

AbstractMedian nerve anatomy is of great interest to clinicians and scientists given the importance of this nerve and its association with diseases. A rare anatomical variant of the median nerve in the distal forearm and wrist was discovered during a cadaveric dissection. The median nerve was deep to the flexor digitorum superficialis (FDS) in the carpal tunnel. It underwent a 360-degree spin before emerging at the lateral edge of FDS. The recurrent motor branch moved from medial to lateral on the deep surface of the median nerve, as it approached the distal carpal tunnel. This variant doesn't fall into any of Lanz's four groups of median nerve anomalies. We propose a fifth group that involves variations in the course of the median nerve. This report underscores the importance of recognizing variants of the median nerve anatomy in the forearm and wrist during surgical interventions, such as for carpal tunnel syndrome.

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