Sonography and MR Imaging of Bifid Median Nerve with Anatomic and Histologic Correlation

Propeck, Tim; Quinn, Timothy J.; Jacobson, Jon A.; Paulino, Augusto F. G.; Habra, G; Darian, Vigen

doi:10.2214/ajr.175.6.1751721

Cited by 93 publications

(62 citation statements)

References 10 publications

(18 reference statements)

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“…7,8,11,26) Anatomical variants such as persistent median artery or bifid median nerve may also be recognized. 16,28) Approximately 10% of patients have vascular anomalies, such as persistent median artery of the forearm, which runs parallel to the median nerve. 9) These anatomical variations are important to recognize, especially in the preoperative setting, because they may influence the way of treatment.…”

Section: Discussionmentioning

confidence: 99%

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Use of Sonography in Carpal Tunnel Syndrome Surgery-A Prospective Study-

Çolak

Kutlay

Pekkafalı

et al. 2007

Neurol. Med. Chir.(Tokyo)

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The diagnosis of carpal tunnel syndrome (CTS) is mainly based on the characteristic symptoms and confirmed with nerve conduction studies. Sonography can provide measurements of the increased cross-sectional area of median nerve. The use of sonography was evaluated for the diagnosis and postoperative follow up of 48 wrists in 26 consecutive patients with CTS. Clinical evaluation and sonography were effective for the diagnosis in 40 wrists. Nerve conduction studies were needed in eight wrists, because of the decrease in cross-sectional area of the nerve as a result of degenerative changes. After 3 months, sonography detected statistically significant decreases in the cross-sectional areas of the median nerves. The sonographic studies were well tolerated by all patients. Sonography was both time-saving and cost-effective.

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Section: Discussionmentioning

confidence: 99%

“…Recently, sonography has been evaluated for the evaluation of patients with CTS, 3,11,[16][17][18][19]21,25,28,31,32,34,35,37) and may be a useful alternative to the nerve conduction study, 7,11,20,21,23,31,34,38) with high sensitivity and specificity. 3,11,25,31,32,34,37) Most studies used nerve conduction as the gold standard.…”

Section: Introductionmentioning

confidence: 99%

Use of Sonography in Carpal Tunnel Syndrome Surgery-A Prospective Study-

Çolak

Kutlay

Pekkafalı

et al. 2007

Neurol. Med. Chir.(Tokyo)

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“…[3][4][5][6] Detection of median nerve anomalies with ultrasonography and MRI, showing 2 nerve trunks in the carpal tunnel, has been reported recently. 23,24 The increasing spatial resolution with the use of a 7-to 15-MHz broadband linear array transducer and the newly developed SonoCT technology leads to better delineation of the perineurium, fascicles, and septal structures within the nerve. This enables the examiner to differentiate high division proximally to the carpal ligament, with complete separation of fascicles and the perineurium, from a mere fascicle regrouping separated by septal structures but enveloped by a common perineurium.…”

Section: Discussionmentioning

confidence: 99%

Persistent Median Artery in the Carpal Tunnel

Gassner

Schocke

Peer

et al. 2002

J of Ultrasound Medicine

111

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Objective. To describe the ultrasonographic and color Doppler ultrasonographic findings in 2 patients with carpal tunnel syndrome associated with a persistent median artery and to report the frequency of this anatomic variation in healthy volunteers. Methods. Two patients with the clinical appearance of carpal tunnel syndrome and 100 wrists and distal forearms of 50 asymptomatic volunteers were examined with ultrasonography and color Doppler ultrasonography. The frequency and size of a persistent median artery and its relationship to median nerve anatomy in the carpal tunnel were evaluated. Results. A large persistent median artery of 3 mm in diameter was found in the affected hands in both patients with carpal tunnel syndrome. Findings were confirmed at surgery. Among the asymptomatic volunteers, a persistent median artery could be found in 13 (26%, 10 [20%] unilateral and 3 [6%] bilateral), with a mean diameter of 1.1 mm (range, 0.5-1.7 mm). In 10 (63%) of 16 hands, the persistent median artery was associated with high division of the median nerve or a bifid nerve configuration in the carpal tunnel. Conclusions. A persistent median artery is a common condition in healthy individuals and in most cases is related to median nerve variations such as high division or a bifid nerve. Because a persistent median artery has a superficial course close to the transverse carpal ligament, preoperative diagnosis of this anatomic variation may be of clinical importance.

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“…1 In previous studies, BMN was reported to be associated with CTS due to its relatively higher cross sectional area (CSA) compared to a non-BMN which may lead compression in carpal tunnel. 1,[11][12][13] However, in a more recent study Granata et al, 14 reported similar frequencies of BMN in patients with CTS and the healthy control group. Hence, we aimed to determine the BMN frequency in patients with CTS and healthy control group, and to investigate the aforementioned association between CTS and BMN in our population.…”

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confidence: 87%

The Association Between Bifid Median Nerve and Carpal Tunnel Syndrome: Is it Really a Risk Factor?

et al. 2014

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Objectives: This study aims to determine the bifid median nerve (BMN) frequency in patients with carpal tunnel syndrome (CTS) and to investigate the possible association between CTS and BMN in this patient population. Patients and methods: A total of 194 wrists of 131 patients in whom CTS was diagnosed clinically and electrophysiologically and 73 healthy volunteers without any symptom or sign of CTS were examined with ultrasonography. Results: Bifid median nerve was detected in 22 wrists (11.3%) in CTS group and 15 wrists (10.2%) in the control group. There was no statistically significantly difference in the incidence of BMN among patients with CTS and healthy volunteers (p=0.891). Conclusion: Our study results showed that the incidence of BMN was similar among CTS patients and healthy volunteers. Therefore, we conclude that BMN may not be a predisposing factor for CTS.

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Sonography and MR Imaging of Bifid Median Nerve with Anatomic and Histologic Correlation

Cited by 93 publications

References 10 publications

Use of Sonography in Carpal Tunnel Syndrome Surgery-A Prospective Study-

Use of Sonography in Carpal Tunnel Syndrome Surgery-A Prospective Study-

Persistent Median Artery in the Carpal Tunnel

The Association Between Bifid Median Nerve and Carpal Tunnel Syndrome: Is it Really a Risk Factor?

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