Median artery revisited

Abstract

This study confirms that the median artery may persist in adult life in 2 different patterns, palmar and antebrachial, based on their vascular territory. The palmar type, which represents the embryonic pattern, is large, long and reaches the palm. The antebrachial type,which represents a partial regression of the embryonic artery is slender, short, and terminates before reaching the wrist. These 2 arterial patterns appear with a different incidence. The palmar pattern was studied in the whole sample (120 cadavers) and had an incidence of 20%, being more frequent in females than in males (1.3:1), occurring unilaterally more often than bilaterally (4:1) and slightly more frequently on the right than on the left (1.1:1). The antebrachial pattern was studied in only 79 cadavers and had an incidence of 76%, being more frequent in females than in males (1.6:1); it was commoner unilaterally than bilaterally (1.5:1) and was again slightly more prevalent on the right than on the left (1.2:1). The origin of the median artery was variable in both patterns. The palmar type most frequently arose from the caudal angle between the ulnar artery and its common interosseous trunk (59%). The antebrachial pattern most frequently originated from the anterior interosseous artery (55%). Other origins, for both patterns, were from the ulnar artery or from the common interosseous trunk. The median artery in the antebrachial pattern terminated in the upper third (74%) or in the distal third of the forearm (26%). However, the palmar pattern ended as the 1st, 2nd or 1st and 2nd common digital arteries (65%) or joined the superficial palmar arch (35%). The median artery passed either anterior (67%) or posterior (25%) to the anterior interosseous nerve. It pierced the median nerve in the upper third of the forearm in 41% of cases with the palmar pattern and in none of the antebrachial cases. In 1 case the artery pierced both the anterior interosseous and median nerves.

Persistent median artery in the carpal tunnel and anastomosis with superficial palmar arch

“…[2] PMA in this study was palmar type which was large, long artery and reached the palm.This type of PMA was reported by similar studies. [11]…”

“…According to Rodriguez-Niedenfuhr et al. [2] the median artery in adult life can be categorized into two different patterns, antebrachial and palmar which is large, long artery and reaches the palm.…”

Persistent Median Artery (Palmar Type) and Median Nerve Block in the Forearm

“…2,3,9,10 When a PMA is patent and reaches the hand, it may form the only blood supply to the median nerve and neighboring muscles and may be a significant supply of blood to the hand by contributing to the superficial palmar arch. 4,9,11,12 Pathology of the PMA has been implicated in median neuropathy and may cause or mimic carpal tunnel syndrome, pronator syndrome, or anterior interosseus syndrome.…”

“…2,3,9,10 We accepted a low range estimate prevalence of 7%, defining statistical significance at 95%, and precision at 5%. Sample size calculations gave a study population of 100.…”

“…Palmar median arteries terminate in the hand and contribute to the blood supply of the digits; these are considered to be an anatomical variant. 2 Reports of this anatomical variation come primarily from cadaveric studies and surgical reports discussing its role in carpal tunnel or pronator syndrome. 2Y5 The mid-forearm approach to the median nerve has only recently become available with advances in ultrasound technology, as there is no reliable landmark technique.…”