MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance

Pierre-Jerome, Claude; Smitson, Robert D.; Shah, Raj Kishor; Moncayo, Valeria; Abdelnoor, Michael; Terk, Michael R.

doi:10.1007/s00276-009-0600-1

Cited by 70 publications

(48 citation statements)

References 30 publications

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“…Thus, the early detection of the thrombosed median artery using ultrasonography can result in prompt anticoagulant therapy, thus preventing the need for any surgery or thrombolytic therapy 10. Although Pierre-Jerome, et al observed that the PMA was more frequently observed on the left side 9, no significant differences between the left and right side of the wrists were observed in the present study. We also detected the coexistence of a persistent median artery with a bifid median nerve in the carpal tunnel in most cases.…”

Section: Discussioncontrasting

confidence: 63%

Sonographic Findings of the Bifid Median Nerve and Persistent Median Artery in Carpal Tunnel: A Preliminary Study in Chinese Individuals

Chen

Chen²,

Hu³

et al. 2017

Clinics

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OBJECTIVE:The aim of this study was to investigate the prevalence of anatomic variations of the bifid median nerve, persistent median artery and persistent median vein in Chinese individuals and their relationship with carpal tunnel syndrome.METHODS:One hundred and sixty median nerves were examined using ultrasonography and colour Doppler ultrasonography. The location, shape, and size of the bifid median nerve, persistent median artery and persistent median vein were recorded. The cross-sectional area of the bifid median nerve (two trunks) was measured at the level of the pisiform.RESULTS:Among the 160 wrists examined, a bifid median nerve was observed in 15 (9.4%) wrists, and a persistent median artery was observed in 12 (7.5%) wrists. These two variations either coexisted or were observed independently, and the probability of coexistence (6.3%) was higher than the probability of existing independently (bifid median nerve only 3.1%, persistent median artery only 1.3%). The cross-sectional area of the radial trunk was greater than (13 in 15, 86.7%) the cross-sectional area of the ulnaris trunk. Persistent median vein was observed in 9 wrists (5.6%).CONCLUSIONS:The persistent median artery and bifid median nerve tend to coexist, and the persistent median vein sometimes runs parallel to the persistent median artery. Their positional relationship in carpal tunnel is uncertain, and thus, preoperative ultrasound is necessary. These three variations do not present any additional risk for the development of carpal tunnel syndrome.

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Section: Discussioncontrasting

confidence: 63%

Sonographic Findings of the Bifid Median Nerve and Persistent Median Artery in Carpal Tunnel: A Preliminary Study in Chinese Individuals

Chen

Chen²,

Hu³

et al. 2017

Clinics

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“…4,5) The utility of these in surgical decision making process needs further study as endoscopic release might be contraindicated if such abnormalities are identified preoperatively. The superficial location of the median artery and the possibility of separate tunnels for individual divisions precludes endoscopic release in these patients as the chances of iatrogenic injury or incomplete release is high.…”

Section: Discussionmentioning

confidence: 98%

Bifid Median Nerve - A Case Report

et al. 2015

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A wide variety of anatomic variations of the median nerve at wrist have been reported and the awareness of these variations are essential for the surgeon treating carpal tunnel pathologies to avoid inadvertent injury to the nerve during surgery. We report a rare case of bifid median nerve accompanied by a persistent median artery found incidentally in a patient who underwent flexor tendon reconstruction for subcutaneous tendon rupture. The current literature regarding the anomaly is reviewed and surgically relevant aspects are discussed.

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“…One important anatomic variation is a bifid median nerve (Figure 11), which occurs in roughly 20% of individuals and is often associated with a persistent median artery (Figure 12). The median artery arises from the ulnar artery and passes along the ulnar side of the median nerve or, if the median nerve is bifid, generally between the 2 median nerves 28 …”

Section: Nervesmentioning

confidence: 99%

Normal Sonographic Anatomy of the Wrist With Emphasis on Assessment of Tendons, Nerves, and Ligaments

Gitto

Draghi

2016

J of Ultrasound Medicine

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Sonography allows for rapid, cost-effective, noninvasive, and dynamic evaluation of soft tissue structures, thus representing a valuable tool for ruling out musculoskeletal disorders of the wrist. Because of the complexity of the wrist joint, sonographic training and familiarity with normal and variant anatomy are needed to avoid misdiagnosis and improper treatment. The aim of this article is to enlighten readers about the structures representing normal findings or common variants during sonographic evaluations of the wrist. The main text reviews the pertinent gross anatomy and procedures that are recommended to assess the soft tissue structures of the wrist, with particular emphasis given to tendons, nerves, and ligaments. Detailed explanations of the scanning techniques and sonographic appearance of the wrist structures are provided in the figure legends.

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MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance

Abstract: There was a high prevalence of bifid median nerve (19%) and PMA (11%) within the tunnel regardless of gender or age. The PMA was more frequent on the left side.

Cited by 70 publications

References 30 publications

Sonographic Findings of the Bifid Median Nerve and Persistent Median Artery in Carpal Tunnel: A Preliminary Study in Chinese Individuals

Sonographic Findings of the Bifid Median Nerve and Persistent Median Artery in Carpal Tunnel: A Preliminary Study in Chinese Individuals

Bifid Median Nerve - A Case Report

Normal Sonographic Anatomy of the Wrist With Emphasis on Assessment of Tendons, Nerves, and Ligaments

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