Arch Hand Microsurg.  2017 Dec;22(4):256-260. 10.12790/ahm.2017.22.4.256.

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

• Kim D
• Park JW
• Choi IC

• KMID: 2406129
• DOI: http://doi.org/10.12790/ahm.2017.22.4.256

Abstract

Among the numerous causes of carpal tunnel syndrome, thrombosed persistent median artery with bifid median nerve is extremely rare. Our presentation shows that an unusual case and surgical outcome of thrombosed persistent median artery with bifid median nerve causing acute carpal tunnel syndrome. Care has to be taken that identification of abnormal anatomy in the carpal tunnel is essential, especially in abruptly occurred carpal tunnel syndrome. We suggest that Doppler ultrasound examination is very useful in an outpatient clinic-based for identification of abnormal structure, which makes more quickly and accurate diagnosis than magnetic resonance image.

Keyword

Carpal tunnel syndrome; Persistent median artery; Bifid median nerve; Occlusion

MeSH Terms

Arteries*
Carpal Tunnel Syndrome*
Diagnosis
Humans
Median Nerve*
Outpatients
Ultrasonography

Figure

• 

  Fig. 1 The Doppler ultrasound. (A) Normal echogenicity and contour of the median nerve (dotted circle) in the healthy wrist. (B) Persistent median artery (lined circle) between the divided median nerves (dotted circles) in the affected wrist.

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  Fig. 2 (A) The thrombosis in about 4 cm length of the persistent median at the wrist on the ultrasound examination. (B) The thrombosis was indicated with arrowhead (arrowheads) on magnetic resonance image.

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  Fig. 3 (A) The persistent median artery was completely obliterated in each 2 cm length proximally and distally from the carpal tunnel inlet. (B) Under the operating microscope, the obstructed artery was resected and ligated proximally.

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