A rare cause of median neuropathy at the carpal tunnel: Thrombosis of the persistent median artery

Abstract

Carpal tunnel syndrome is a common peripheral nerve entrapment neuropathy caused due to compression of the median nerve at the level of the wrist joint. Bifid median nerve associated with a persistent median artery is a rare entity and in itself asymptomatic anatomical variant. However, distension of the persistent median artery due to a thrombus can be symptomatic due to compression on the median nerve and can compromise the blood flow to the palm. We report a case of persistent median artery thrombosis in a young female patient who presented with symptoms of carpal tunnel syndrome diagnosed on the ultrasonography and confirmed on the MRI with subsequent improvement post anticoagulation therapy.

A Persistent Median Artery Piercing the Median Nerve: A Review and Clinical Implications

“…Additionally, this artery pierced the median nerve and was found to have the same anatomical composition bilaterally. Although persistent median arteries contributing to a portion of the hand's blood supply have been described, none appeared to have made as signi cant a contribution as was seen in this case [4,5]. Haladaj et al reported various contributions to the super cial palmar arch, however the extent of vascular supply was less than in this case.…”

Thrombosed Persistent Median Artery with Coexisting Bifid Median Nerve in a Robotic Arthroplasty Surgeon

“…Rarely, PMAs have been found to coexist with a bifid median nerve (BMN) [6][7][8][9][10][11][12] . The presence of a persistent median artery (PMA) has been reported to be associated with the occurrence of compression neuropathy 2,3,5,[13][14][15] -caused directly or secondary to associated pathology of the PMA including calcification, atherosclerosis, and thrombosis [16][17][18][19][20][21][22][23][24] .…”