Carpal tunnel syndrome due to compression by an anomalous median artery

Boles, D M; Tobias, P.V.; Spiro, F.I.

doi:10.1016/s0090-3019(82)80028-1

Cited by 15 publications

(9 citation statements)

References 3 publications

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“…[11][12][13][14][15][16][17][18] Our study suggests that a perfused PMA reaching the carpal tunnel is a common condition in healthy individuals, which can be detected on high-resolution ultrasonography and CDUS at a frequency similar to that described in previous anatomic studies. In contrast to studies on cadaveric extremities, CDUS examination can show vessel flow, and a bilateral occurrence can be proved.…”

supporting

confidence: 70%

“…[11][12][13][14][15][16][17][18] Although a PMA has been described as an anatomic variation in angiographic studies, 19,20 to our knowledge, no report of ultrasonographic findings of a PMA associated with CTS has been published. We report the cases of 2 patients with a large PMA in association with CTS diagnosed on the basis of ultrasonography and color Doppler ultrasonography (CDUS).…”

mentioning

confidence: 99%

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Persistent Median Artery in the Carpal Tunnel

Gassner

Schocke

Peer

et al. 2002

J of Ultrasound Medicine

108

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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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supporting

confidence: 70%

mentioning

confidence: 99%

Persistent Median Artery in the Carpal Tunnel

Gassner

Schocke

Peer

et al. 2002

J of Ultrasound Medicine

108

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“…Although most individuals with a persistent median artery seem to be asymptomatic, a median artery of 3 mm in diameter or larger (Boles et al, 1982;Gassner et al, 2002) or a thrombosed median artery (Fumière et al, 2002;Kele et al, 2002) can be causes of CTS. At least two studies have found the frequency of a persistent median artery to be approximately 2% (Boles et al, 1982;Luyendijk, 1986), a percentage equal to that observed in our study. A recent study by Gassner et al (2002) using ultrasonography and color Doppler ultrasonography for diagnosis found, however, that 16% of 100 hands examined in 50 asymptomatic volunteers had persistent median arteries.…”

Section: Discussionmentioning

confidence: 99%

Coexistence of multiple anomalies in the carpal tunnel

et al. 2005

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We determined the frequency of anomalous structures within the carpal tunnels of 89 cadaveric forearm-hand specimens. We also examined these same specimens for variations in the branching pattern of the median nerve, and analyzed the range in length and width of the lumbricals. Many of the hands contained extra tendinous slips from the long flexors within the tunnel, subligamentous thenar branches of the median nerve, or lumbricals with bipennate origins. Only one hand had an anomalous muscle belly within the tunnel, two had persistent median arteries, two had high division of the median nerve in the distal forearm, and eight had lumbricals with lengths or widths that were greater or less than 2 standard deviations (SD) from the mean. Twenty-nine percent of all hands examined had two to five anomalies/variations per tunnel, whereas another 27% had one anomaly or variation per tunnel. More right hands (17%) than left (11%) contained two to five anomalous/variant structures per carpal tunnel. More right hands (19%) than left (8%) contained only one variant/anomalous structure per carpal tunnel. Anticipation of the frequency and multiplicity of anomalous structures and variations within this region is of importance to clinicians, particularly surgeons.

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“…Anatomical variations in the median nerve itself, as well as anomalous muscles, tendons, or tissue interconnections, have been described as a basis for atypical presentations. 14,51,77,118,129 Nerve fibers have layers of connective tissue. The extensibility of these layers is critical to nerve gliding.…”

Section: A Pathophysiologic Basis For Clinical Examinationmentioning

confidence: 99%

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

MacDermid¹,

Doherty²

2004

J Orthop Sports Phys Ther

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Carpal Tunnel Syndrome (CTS) is a pressure-induced neuropathy that causes sensorimotor disturbances of the median nerve, which impair functional ability. A clear history that elicits relevant personal and work exposures and the nature of symptoms can lead to a high probability of a correct diagnosis. Hand diagrams and diagnostic questionnaires are available to provide structure to this process. A variety of provocative tests have been described and have variable accuracy. The Phalen's wrist flexion and the carpal compression tests have the highest overall accuracy, while Tinel's nerve percussion test is more specific to axonal damage that may occur as a result of moderate to severe CTS. Sensory evaluation of light touch, vibration, or current perception thresholds can detect early sensory changes, whereas 2-point discrimination changes and thenar atrophy indicate loss of nerve fibers occurring with more severe disease. Electrodiagnosis can encompass a variety of tests and is commonly used to assess the presence/severity of neuropathic changes and to preclude alternative diagnoses that overlap with CTS in presentation. The pathophysiologic changes occurring with different stages of nerve compression must be considered when interpreting diagnostic test results and predicting response to physical therapy management.

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Carpal tunnel syndrome due to compression by an anomalous median artery

Cited by 15 publications

References 3 publications

Persistent Median Artery in the Carpal Tunnel

Persistent Median Artery in the Carpal Tunnel

Coexistence of multiple anomalies in the carpal tunnel

Clinical and Electrodiagnostic Testing of Carpal Tunnel Syndrome: A Narrative Review

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