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

Duymuş, Mahmut; Orman, Güneş; Özben, Serkan; Huseyinoglu, Nergiz; Ulaşlı, Alper Murat

doi:10.5606/archrheumatol.2014.3712

Cited by 4 publications

(2 citation statements)

References 21 publications

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“…The second screening was conducted as the full‐text manuscript was sorted. In total, 29 studies were included (Lanz, 1977; Tountas et al, 1987; Amadio, 1988; Iannicelli et al, 2000; Propeck et al, 2000; Gassner et al, 2002; Lindley & Kleinert, 2003; Bayrak et al, 2008; Szopinski & Mazurczak‐Pluta, 2009; Pierre‐Jerome et al, 2010; Granata et al, 2011; Klauser et al, 2011; Mhoon et al, 2012; Walker et al, 2013; Agarwal et al, 2014; Beary et al, 2014; Duymuş et al, 2014; Kasius et al, 2014; Sripathi, Sripathi et al, 2016; Billakota & Hobson‐Webb, 2017; Cartwright et al, 2017; Chen et al, 2017; Kalathummarath, 2017; Petrover et al, 2017; Trachani et al, 2018; Shinagawa et al, 2019; Haris et al, 2021; Park et al, 2021; Dag et al, 2022). These studies were divided into two groups: (a) seven cross‐sectional studies with matching normal or healthy controls, in which the pooled odds ratio and mean difference in CSA were computed (five studies); and (b) 24 cross‐sectional studies without matching control or CTS subjects, in which only the pooled prevalence was computed. The pooled odds ratio of BMN between CTS and normal or control population: 248 BMNs were reported from 2186 CTS wrists, and 100 were reported from 1311 normal (control) wrists.…”

Section: Resultsmentioning

confidence: 99%

Bifid median nerve as an anatomical risk factor for carpal tunnel syndrome: A meta‐analysis

et al. 2022

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As the median nerve enters the carpal tunnel, it is a single nerve that soon bifurcates into lateral and medial branches into the hand. If the bifurcation is proximal to the carpel tunnel, a bifid median nerve (BMN) results. Carpal tunnel syndrome is often associated with a BMN with or without a persistent median artery. Individual keywords and MeSH phrases were searched in the Google Scholar, SCOPUS, and PubMed databases. Full texts were then collected and assessed for suitability. The prevalence of BMN at the wrist joint in normal and carpal tunnel syndrome wrists (precanal part) and the mean difference between groups were recorded. Only human data were used to test the findings. The pooled odds ratio (with minimal heterogeneity) was 1.50 [1.17–1.93, 95% CI]. The BMN cross‐sectional area (CSA) was significantly greater than that of a solitary median nerve in normal wrists. The mean difference in CSA between the two was 1.50 mm2 [0.56–2.45 mm2, 95% CI] without heterogeneity (i2 = 0). Sex and laterality distributions scarcely differed between the two types of wrists. Owing to the insufficiency of data, the relationships with mean height and weight were not examined. There was a 50% greater incidence of bifid median nerves in carpal tunnel syndrome patients than in normal subjects. A bifid median nerve increases the mean CSA at the wrist joint by 1.5 mm2. These findings indicate that the bifid median nerve is an anatomical risk factor for carpal tunnel syndrome.

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Section: Resultsmentioning

confidence: 99%

Bifid median nerve as an anatomical risk factor for carpal tunnel syndrome: A meta‐analysis

et al. 2022

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“…Another US study showed a similar prevalence between CTS patients and healthy controls and concluded that the bifid median nerve might not be a predisposing factor for CTS. 19 Prior studies reported that the presence of a bifid median nerve might be a risk factor for CTS surgical failure. Jones reported a case of failed bilateral carpal tunnel release as a result of bilateral anomalous palmaris profundus tendons and a bifid median nerve proximal to the flexor retinaculum.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Bifid Median Nerve and the Cross-Sectional Area as Assessed by Ultrasonography in Healthy Japanese Subjects

Shinagawa

Tajika

Oya

et al. 2019

Journal of Hand Surgery Global Online

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Purpose: Ultrasonography is useful for evaluating anatomical variations of the median nerve and aids in diagnosing carpal tunnel syndrome by assessing the cross-sectional area (CSA) at the carpal tunnel inlet. The purposes of this study were to investigate the prevalence of the bifid median nerve and to establish reference values for the CSA at the carpal tunnel inlet in healthy participants. Methods: A total of 349 Japanese participants were included (121 men and 228 women, mean age 66.3 years). Study participants underwent ultrasonography to assess the CSA of the median nerve at the carpal tunnel inlet of the bilateral wrist. First, we investigated the prevalence of the bifid median nerve in 349 participants. Then, we assessed the relation between the CSA and clinical factors (age, height, weight, body mass index, fat mass, fat-free mass, bilateral grip strength, and key pinch strength) in healthy participants. Results: Among the 349 participants, 59 (16.9%) had a bifid median nerve. Mean CSA in healthy participants (no bifid median nerve) was 9.7 ± 2.9 mm 2 in women and 9.0 ± 1.8 mm 2 in men (both: 9.4 ± 2.6 mm 2). In women, mean CSA in subjects in their sixties was significantly higher than in younger subjects, and we found a significant positive correlation between the CSA and the fat-free mass. Conclusions: In this observational study of healthy Japanese, the prevalence of the bifid median nerve was 16.9%; the mean CSA was 9.7 ± 2.9 mm 2 in women and 9.0 ± 1.8 mm 2 in men. Older women had a larger CSA than did younger women. Clinical relevance: This study describes the prevalence of the bifid median nerve and normative values for the CSA of the median nerve precisely diagnose carpal tunnel syndrome to more by ultrasonography.

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Bifid median nerve in a patient with carpal tunnel syndrome: A case report and literature review

Narayan

2016

Australas J Ultrason Med

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A middle‐aged man with Carpal tunnel syndrome without any known predisposing risk factors is presented. Ultrasonography demonstrated two structures within the left carpal tunnel with similar echo pattern as median nerve, thus confirming an anatomical variation in the median nerve, described in the literature as bifid median nerve. The knowledge of the existence of bifid median nerve is an important factor in planning surgical decompression of median nerve to avoid nerve and persistent median artery injuries and/or potential relapse if decompression of both branches is not carried out. In addition, this knowledge is important in deciding whether to inject above the bifurcation or into the epineurial of individual nerve trunks in the setting of planned symptomatic corticosteroid injections. In conclusion, bifid median nerve is an anatomic variant that may contribute to carpal tunnel syndrome and can be demonstrated ultrasonographically. It is important to be aware of this anomaly when planning carpal tunnel release surgery and symptomatic corticosteroid injections.

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

Cited by 4 publications

References 21 publications

Bifid median nerve as an anatomical risk factor for carpal tunnel syndrome: A meta‐analysis

Bifid median nerve as an anatomical risk factor for carpal tunnel syndrome: A meta‐analysis

Prevalence of Bifid Median Nerve and the Cross-Sectional Area as Assessed by Ultrasonography in Healthy Japanese Subjects

Bifid median nerve in a patient with carpal tunnel syndrome: A case report and literature review

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