Prevalence of bifid median nerves and persistent median arteries and their association with carpal tunnel syndrome in a sample of latino poultry processors and other manual workers

Abstract

Introduction The prevalence of bifid median nerves and persistent median arteries, their co-occurrence, and their relationship to carpal tunnel syndrome (CTS) are only understood partially. Methods We screened 1026 wrists of 513 Latino manual laborers in North Carolina for bifid median nerves and persistent median arteries using electrodiagnosis and ultrasound. Results A total of 8.6% of wrists had a bifid median nerve, and 3.7% of wrists had a persistent median artery independent of subgroup ethnicity, age, gender, or type of work. An association with definite carpal tunnel syndrome was not found. The presence of either anatomic variant was associated with a high likelihood of co-occurrence of another variant in the same or the contralateral wrist. Conclusions The occurrence of median anatomic variants can be determined in field studies using ultrasound. Persistent median arteries and bifid median nerves tend to co-occur but do not put manual laborers at additional risk of developing CTS.

Bifid median nerve in carpal tunnel syndrome: Do we need to know?

“…The prevalence of bifid median nerves has been described previously in surgical, MR, and ultrasound studies . Our study showed that the occurrence of bifid median nerve is equal in patients with CTS (15.8%) and controls (18.5%).…”

“…The reported frequency of bifid median nerves varies from 0.8% to 21% in patients with CTS, and up to 18% were found in a retrospective study with MRI scans performed for various medical reasons . The frequency in healthy subjects is reported to be approximately 8–15% . However, no significant association between the prevalence of bifid median nerves and CTS was found in a recent study among a large population of manual workers .…”

“…The frequency in healthy subjects is reported to be approximately 8–15% . However, no significant association between the prevalence of bifid median nerves and CTS was found in a recent study among a large population of manual workers . In addition to variable data on frequency, data about electrophysiologic findings and outcome in patients with CTS and bifid median nerves are scarce.…”

Bilateral Triad of Persistent Median Artery, a Bifid Median Nerve and High Origin of its Palmar Cutaneous Branch: A Case Report and Clinical Implications

“…This is in contrast with the most common origin of the PMA, which usually originates between the caudal angle between common interosseous artery (Rodríquez-Niedenführ et al, 1999). Walker et al (2013) reported a 3.7 % incidence of the bifid nerve, 8 % with a concomitant occurrence with a PMA. Other documented anomalies related to motor branch of the MN besides the bifid MN include ulnar and anterior take off of the motor branch, transligamentous and subligamentous course of the motor branch (Lindley & Kleneirt).…”

Thrombosed Persistent Median Artery with Bifid Median Nerve Causing Acute Carpal Tunnel Syndrome: A Case Report

“…In contrast, some authors recently reported that the bifid median nerve is not an independent risk factor for development of carpal tunnel syndrome 7,9 . Meanwhile, co-existence of the bifid median nerve and persistent median artery was suggested by several authors 2,9 . Embryologically, the upper limb develops at the end of four weeks to eight weeks gestation.…”