Trifid Median Nerve: A Rare Variant in a Patient With Carpal Tunnel Syndrome

Cai, Haibi; Annaswamy, Thiru M.

doi:10.1097/phm.0000000000001057

Cited by 4 publications

(1 citation statement)

References 2 publications

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“…According to Siddiq et al, the diameter of each trifid median nerve was 0.02, 0.05, and 0.09 cm 2 9 and according to Cai and Annaswamy, each nerve branch diameter was 0.03, 0.03, and 0.08 cm 2 . 14 There are no significant differences in each median nerve branch in a trifid median nerve in other cases to date; the diameter of each median nerve branch in our case was also similar to that in other cases. In particular, each median nerve diameter was 0.43, 0.45, and 0.48 cm 2 in the proximal wrist crease in our case.…”

Section: Discussionsupporting

confidence: 80%

Trigger Wrist with Carpal Tunnel Syndrome Accompanied with Trifid Median Nerve: A Case Report and Literature Review

Oh¹

2022

Arch Plast Surg

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Trigger wrist, characterized by a clicking or snapping sensation around the wrist joint during finger or wrist motion, and bifid or trifid median nerve, which occurs in carpal tunnel syndrome along with anatomical variation of median nerve, are rare conditions. We report the case of a patient with a thickened tendon caused by severe tenosynovitis and flexor tendon subluxation to the hamate hook due to bowing of the flexor retinaculum, thereby resulting in trigger wrist as well as an anatomical median nerve variation (bifid median nerve in the right wrist and trifid median nerve in the left wrist). A 59-year-old housewife visited our hospital with bilateral fingertip numbness, tingling sensation, and aggravated severe night cramping that began 2 months ago. She also complained about trigger wrist during small finger flexion. Based on magnetic resonance imaging, ultrasonography, and nerve conduction study, trifid median nerve and bilateral severe median nerve neuropathy of the wrist were diagnosed; therefore, transverse carpal tunnel release and exploration under wide-awake anesthesia were planned. Intraoperative findings showed trifid and bifid median nerves in left and right wrists, respectively. Additionally, bowing of flexor retinaculum and severe flexor tendon tenosynovitis were observed. Tenosynovitis with thickened flexor sheath resulted in subluxation of small finger flexor tendon above the hamate hook. After transverse carpal ligament release with antebrachial fascia release and tenosynovectomy, subluxation of the flexor tendon was resolved. At 6 months postoperatively, the tingling and dullness in fingertips also resolved, and no trigger wrist or any other complications were noted.

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Section: Discussionsupporting

confidence: 80%