Persistent median artery inside the carpal tunnel: description and surgical implications

Abstract

The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.

The persistent median artery: A case report of maintained perfusion to the hand after laceration to radial and ulnar arteries

“…The median artery is a transitory vessel normally present during early embryonic development, initially serving as the main blood supply to the hand [4][5][6][7] . As the radial and ulnar arteries develop, the median artery usually regresses via apoptosis around the 8 th week of gestation.…”

“…Similarly, a 2009 review article presented 27 studies which collectively demonstrated a prevalence of 6.8% (0.6-44.2%) amongst all ages, with higher prevalence rates occurring in neonate cadavers and lower rates in adult cadaver studies. 9 A PMA can contribute to pronator syndrome, anterior interosseous nerve (AIN) syndrome, or carpal tunnel syndrome, especially in the case of thrombosis, aneurysm, or atherosclerosis of the PMA [6,10] . The origin and palmar termination of the PMA in the hand is highly variable.…”

An Anatomical Variation of Median Artery of Forearm and Palm: Cadaveric Study into its Origin and Course

“…8 Alexander et al reported-on study conducted on left upper limb of formalin preserved fifty-to-sixty-year adults showed that palmar variants of persistent median artery were observed. 9 Raviprasanna et al conducted a study on fifty human cadavers from 2011-2013. 10 Out of fifty human cadavers, four median arteries (eight percent) were arising from anterior interosseous artery (palmar variant).…”

Conservative treatment for Carpal Tunnel Syndrome caused by persistent median artery: a case report

“…The median artery is a transient vessel that develops from the axial artery of the upper limb at the beginning of embryonic life (Alexander, Leal, & Baptista, 2020). It follows the median nerve and can be a part of the structure of the superficial palmar arch.…”