Median artery in carpal tunnel syndrome

Barfred, Troels; Højlund, Anders Peter; Bertheussen, K.

doi:10.1016/s0363-5023(85)80163-5

Cited by 72 publications

(69 citation statements)

References 9 publications

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“…It develops from the axillary artery and usually regresses in the second embryonic month. Barfred et al (35) reported nine patients in whom a persistent median artery was noted within the carpal tunnel at the time of carpal tunnel release. Since this report, smaller case series (33) and case reports (36,37) have been published.…”

Section: Vascular Anatomical Variations Persistent Median Arterymentioning

confidence: 99%

Anatomical variations of the carpal tunnel structures

Mitchell¹,

Chesney²,

Seal³

et al. 2009

CAN J PLAST SURG

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Asurgeon's expert competency should include an appreciation of anatomical variations, particularly with respect to common surgical procedures. One such procedure where this is relevant to plastic surgeons is the carpal tunnel release. The carpal tunnel has been recognized as a site where multiple anatomical variations can occur. These variations can involve neural, vascular, tendinous and muscular structures. If these are unrecognized, there is a risk of iatrogenic injury to the involved structures leading to unfavourable surgical outcomes. The purpose of the present review is to highlight recognized anatomical variations within the carpal tunnel and, hopefully, to help practitioners perform safe surgery. The Carpal TunnelThe carpal tunnel is defined as the space deep to the transverse carpal ligament. The transverse carpal ligament extends ulnarly from the hook of hamate and the triquetrum to the scaphoid and the trapezium radially. The carpal tunnel is bordered posteriorly by the carpal bones. Within the carpal tunnel lie the median nerve and nine flexor tendons: the flexor digitorum profundus (FDP) and flexor digitorum superficialis (FDS) tendons to the index, middle, ring and small fingers, as well as the flexor pollicis longus (FPL) tendon. A review of the literature identified variations in the structure within and around the carpal tunnel (Table 1). VariaTion in nerVe anaTomyhigh bifurcation of the median nerve In most subjects, the median nerve courses through the carpal tunnel as a single nerve, dividing to form the digital nerves distal to the transverse carpal ligament. Bifurcation of the median nerve proximal to the transverse carpal ligament is a relatively common anatomical variation present in 1% to 3.3% of individuals undergoing carpal tunnel release surgery (Figure 1) (1-3). High bifurcation of the median nerve can be an isolated finding (7) or it can be associated with a persistent median artery (4) or an accessory muscle belly of the long finger flexor superficialis (1,5,6). A case of a bifid median nerve wherein the radial-sided branch was located in its own compartment within the carpal tunnel has been identified by the senior author (AT) (Figure 2). To our knowledge, this is the first report of this variation. This additional compartment was also released with satisfactory outcome. There are many anatomical variations in and around the carpal tunnel that affect the nerves, tendons and arteries in this area. Awareness of these variations is important both during the clinical examination and during carpal tunnel release. The purpose of the present review is to highlight recognized anatomical variations within the carpal tunnel including variation in nerve anatomy, tendon anatomical variants, vascular anatomical variations and muscle anatomical variations.

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Section: Vascular Anatomical Variations Persistent Median Arterymentioning

confidence: 99%

Anatomical variations of the carpal tunnel structures

Mitchell¹,

Chesney²,

Seal³

et al. 2009

CAN J PLAST SURG

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“…A PMA has been discussed as a possible cause for CTS in series by Eversman 9 and Barfred et al 10 and in several reports in the surgical literature. [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.…”

mentioning

confidence: 99%

“…An enlarged, thrombosed, or calcified PMA and a PMA aneurysm in the carpal tunnel were considered causes for CTS in studies by Eversmann 9 and Barfred et al 10 as well as in several case reports in the surgical literature. [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.…”

mentioning

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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“…[3] In the upper forearm region a variant course of the median artery through the median nerve or some of its branches could be a cause of "pronator teres syndrome" [24] and "anterior interosseus nerve syndrome". [25] In the carpal tunnel, a median artery of palmar type, especially with an external diameter more than 2.0 mm, [26] can increase the pressure on the median nerve and thus to be blamed as a cause of carpal tunnel syndrome [3,4,27] described in a number of surgical case reports. [28][29][30][31] Sometimes, median artery injuries such as thrombosis, [25,[32][33][34][35] aneurysm, [36] calcification [37] and traumatic rupture [38] have been identified as causes of carpal tunnel syndrome.…”

Section: Discussionmentioning

confidence: 99%

A rare case of superficial median artery of high brachial origin: anatomical and clinical considerations of the superficial brachiomedian artery

Георгиев¹

2011

Anatomy

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A rare case of median artery with unusually high origin and superficial course, also termed superficial brachiomedian artery, was observed during routine anatomical dissection of the right upper extremity of a 63-year-old Caucasian female cadaver. The aberrant artery arose from the initial part of the brachial artery. In the arm region it followed a superficial course and at the elbow passed beneath the bicipital aponeurosis. In the upper third of the forearm, the variant artery passed under the muscular belly of the palmaris longus and flexor digitorum superficialis muscle. Accompanying the median nerve, the unusual median artery passed through the carpal tunnel and participated in the formation of the superficial palmar arch. Due to its variant course and location, the superficial brachiomedian artery may cause compression on the nerve within the carpal tunnel or nerve ischemia may result from an accidental arterial injury.

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Median artery in carpal tunnel syndrome

Cited by 72 publications

References 9 publications

Anatomical variations of the carpal tunnel structures

Anatomical variations of the carpal tunnel structures

Persistent Median Artery in the Carpal Tunnel

A rare case of superficial median artery of high brachial origin: anatomical and clinical considerations of the superficial brachiomedian artery

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