Persistent median artery in the carpal tunnel: anatomy, embryology, clinical significance, and review of the literature

• Autorzy: Natsis K , Iordache G. , Gigis I. , Kyriazidou A. , Lazaridis N. , Noussios G. , Paraskevas G.
• Języki publikacji: EN

Abstrakty

EN

The median artery usually regresses after the eighth week of intrauterine life, but in some cases it persists into adulthood. The persistent median artery (PMA) passes through the carpal tunnel of the wrist, accompanying the median nerve. During anatomical dissection in our department, we found two unilateral cases of PMA originating from the ulnar artery. In both cases the PMA passed through the carpal tunnel, reached the palm, and anastomosed with the ulnar artery, forming a medio-ulnar type of superficial palmar arch. In addition, in both cases we observed a high division of the median nerve before entering the carpal tunnel. Such an artery may result in several complications such as carpal tunnel syndrome, pronator syndrome, or compression of the anterior interosseous nerve. Therefore, the presence of a PMA should be taken into consideration in clinical practice. This study presents two cases of PMA along with an embryological explanation, analysis of its clinical significance, and a review of the literature. The review of the literature includes cases observed during surgical procedures or anatomical dissections. Cases observed by means of imaging techniques were not included in the study. (Folia Morphol 2009; 68, 4: 193–200)

Słowa kluczowe

EN

median artery; carpal tunnel syndrome; blood vessel; superficial palmar arch; ulnar artery; anatomy; persistent median artery

• Wydawca: -
• Czasopismo: Folia Morphologica
• Rocznik: 2009
• Tom: 68
• Numer: 4
• Opis fizyczny: p.193-200,fig.,ref.

Twórcy

autor

Natsis K

• Aristotle University of Thessaloniki, Greece

autor

Iordache G.

autor

Gigis I.

autor

Kyriazidou A.

autor

Lazaridis N.

autor

Noussios G.

autor

Paraskevas G.

Bibliografia

• 1. Acaturk TO, Tuncer U, Aydogan LB, Dalay AC (2008) Median artery arising from the radial artery: its significance during harvest of a radial forearm free flap. J Plast Reconstr Aesthet Surg, 61: 5–8.
• 2. Ahn DS, Yoon ES, Koo SH, Park SH (2000) A prospective study of the anatomic variations of the median nerve in the carpal tunnel in Asians. Ann Plast Surg, 44: 282–287.
• 3. Arey LB (1974) Developmental anatomy. A textbook and laboratory manual of embryology. W.B. Saunders Company, Philadelphia, London.
• 4. Balakrishnan C, Emanuele JA, Smith MF (1997) Asymptomatic persistent median artery in a trauma patient. Injury, 28: 697–698.
• 5. Balakrishnan C, Smith MF, Puri P (1999) Acute carpal tunnel syndrome from thrombosed persistent median artery. J Emerg Med, 17: 437–439.
• 6. Barbe M, Bradfield J, Donathan M, Elmaleh J (2005) Coexistence of multiple anomalies in the carpal tunnel. Clin Anat, 18: 251–259.
• 7. Barfred T, Hojlund AP, Bertheussen K (1985) Median artery in carpal tunnel syndrome. J Hand Surg, 10 (6 Part 1): 864–867.
• 8. Bataineh ZM, Moqattash ST (2006) A complex variation in the superficial palmar arch. Folia Morphol, 65: 406–409.
• 9. Beran SJ, Friedman RM, Kassir M (1997) Recurrent digital ischemia due to thrombosis of the persistent median artery. Plast Reconstr Surg, 99: 1169–1171.
• 10. Bilge O, Pinar Y, Özer MA, Gövsa F (2006) A morphometric study on the superficial palmar arch of the hand. Surg Radiol Anat, 28: 343–350.
• 11. Bilgin SS, Olcay SE, Derincek A, Adiyaman S, Demirtas AM (2004) Can simple release relieve symptoms of carpal tunnel syndrome caused by a persistent median artery? Clinical experience. Arch Orthop Trauma Surg, 124: 154–156.
• 12. Boles DM, Tobias PV, Spiro F (1982) Carpal tunnel syndrome due to compression by an anomalous median artery. Surg Neurol, 17: 99–100.
• 13. Chalmers J (1978) Unusual cases of peripheral nerve compression. The Hand, 10: 168–175.
• 14. Claasen H, Schmitt O, Wree A (2008) Large patent median arteries and their relation to the superficial palmar arch with respect to history, size consideration and clinic consequences. Surg Radiol Anat, 30: 57–63.
• 15. Coleman SS, Anson BJ (1961) Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet, 113: 409–424.
• 16. D’Costa S, Narayana K, Narayan P, Jiji, Nayak SR, Madhan SJ (2006) Occurrence and fate of palmar type of median artery. ANZ J Surg, 76: 484–487.
• 17. Dickinson JC, Kleinert JM (1991) Acute carpal-tunnel syndrome caused by a calcified median artery. J Bone Joint Surg, 73A: 610–611.
• 18. Faithfull DK, Wallace RF (1987) Traumatic rupture of median artery an unusual cause for acute median nerve compression. J Hand Surg, 12B: 233–235.
• 19. Fazan VP, Borges CT, Da Silva JH, Caetano AG, Filho OA (2004) Superficial palmar arch: an arterial diameter study. J Anat, 204: 307–311.
• 20. Feldkamp MM, Gentili F, Hudson AR, Guha A (1995) A persistent median artery causing carpal tunnel syndrome in a patient with chronic renal failure: case report. Neurosurgery, 37: 140–143.
• 21. Gainor BJ, Jeffries JT (1987) Pronator syndrome associated with a persistent median artery. J Bone Joint Surg Am, 69: 303–304.
• 22. Galassi E, Benefati A, Tognetti F, Pozzati E (1980) Persistence of the median artery: possible cause of the carpal tunnel syndrome. Riv Neurol, 50: 159–166.
• 23. Gellman H, Botte MJ, Shankwiler J, Gelberman RH (2001) Arterial patterns of the deep and superficial palmar arches. Clin Orthop Relat Res, 383: 41–46.
• 24. George BJ, Henneberg M (1996) High frequency of the median artery of the forearm in South African newborns and infants. S Afr Med J, 86: 175–176.
• 25. Gutowski KA, Olivier WA, Mehrara BJ, Friedman DW (2000) Arteriovenous malformation of a persistent median artery with a bifurcated median nerve. Plast Reconstr Surg, 106: 1336–1339.
• 26. Henneberg M, George BJ (1992) High incidence of the median artery of the forearm in a sample of recent South African cadavers. J Anat, 180: 185–188.
• 27. Hollinshead WH (1966) Textbook of anatomy. IBH, Calcutta.
• 28. Ikeda A, Ugawa A, Kazihara Y, Hamada N (1988) Arterial patterns in the hand based on a three-dimensional analysis of 220 cadaver hands. J Hand Surg, 13A: 501–509.
• 29. Jackson IT, Campbell JC (1970) An unusual cause of carpal tunnel syndrome. A case of thrombosis of the median artery. J Bone Joint Surg, 52B: 330–333.
• 30. Jelicic N, Gajicin S, Zbrodowski A (1988) Arcus palmaris superficialis. Acta Anat (Basel), 132: 187–190.
• 31. Jones NF, Ming NL (1988) Persistent median artery as a cause of pronator syndrome. J Hand Surg, 13A: 728–732.
• 32. Keen JA (1961) A study of the arterial variations in the limbs, with special reference to symmetry of vascular patterns. Am J Anat, 108: 245–261.
• 33. Khashaba A (2002) Carpal tunnel syndrome from thrombosed persistent median artery. J Emerg Med, 22: 55–57.
• 34. Koebke J, Schäfer W, Aust T (1999) Carpal tunnel topography during endoscopic decompression. J Hand Surg Br, 24: 3–5.
• 35. Kopuz C, Baris S, Gulman B (1997) A further morphological study of the persistent median artery in neonatal cadavers. Surg Radiol Anat, 19: 403–406.
• 36. Kopuz C, Gulman B, Baris S (1995) Persistent median artery: an anatomical study in neonatal and adult cadavers. Acta Anat Nippon, 70: 577–580.
• 37. Król A, Palczak A, Jędrzejewski KS (2005) Split median nerve. A report of two cases. Folia Morphol, 64: 341–344.
• 38. Kumar MR (2004) Multiple arterial variations in the upper limb of a South Indian female cadaver. Clin Anat, 17: 233–235.
• 39. Levy M, Pauker M (1978) Carpal tunnel syndrome due to thrombosed persisting median artery. A case report. The Hand, 10: 65–68.
• 40. Libersa Cl, Francke JP, Mauppin JM, Bailleul JP, Gamblin Ph (1982) The arterial supply to the palm of the hand. Clin Anat, 4: 33–45.
• 41. Lindley SG, Kleinert JM (2003) Prevalence of anatomic variations encountered in elective carpal tunnel release. J Hand Surg, 28A: 849–855.
• 42. Luyendijk W (1986) The carpal tunnel syndrome. The role of a persistent median artery. Acta Neurochir (Wien), 79: 52–57.
• 43. McCormack LJ, Cauldwell EW, Anson BJ (1953) Brachial and antebrachial arterial patterns. A study of 750 extremities. Surg Gynecol Obstet, 96: 43–54.
• 44. Nayak SR, Krishnamurthy A, Kumar SM, Prabhu LV, Potu BK, D’Costa S, Ranade AV (2009) Palmar type of median artery as a source of superficial palmar arch: A cadaveric study with its clinical significance. Hand, DOI 10.1007/s11552–009–9197–4 (in press).
• 45. Olave E, Prates JC, Gabrielli C, Pardi P (1997) Median artery and superficial palmar branch of the radial artery in the carpal tunnel. Scand J Plast Reconstr Hand Surg, 31: 13–16.
• 46. Pecket P, Gloobe H, Nathan H (1973) Variations in the arteries of the median nerve. With special consideration on the ischemic factor in the carpal tunnel syndrome. Clin Orthop Relat Res, 97: 144–147.
• 47. Patnaik VVG, Kalsey G, Singla RK (2000) Superficial palmar arch duplication. A case report. Anat Soc India, 49: 63–66.
• 48. Proudman TW, Menz PJ (1992) An anomaly of the median artery associated with anterior interosseous nerve syndrome. J Hand Surg, 17B: 507–509.
• 49. Rodriguez-Baeza A, Nebot J, Ferreira B, Reina F, Pérez J, Sanudo JR, Roig M (1995) An anatomical study and ontogenetic explanation of 23 cases with variations in the main pattern of the human brachio-antebrachial arteries. J Anat, 187: 473–479.
• 50. Rodriguez-Niedenführ M, Sanudo JR, Vázquez T, Nearn L, Logan B, Parkin I (1999) Median artery revisited. J Anat, 195: 57–63.
• 51. Rodriguez-Niedenführ M, Burton GJ, Deu J, Sanudo JR (2001) Development of the arterial pattern in the upper limb of staged human embryos: normal development and anatomic variations. J Anat, 199: 407–417.
• 52. Sanudo JR, Chikwe J, Evans SE (1994) Anomalous median nerve associated with persistent median artery. J Anat, 185: 447–451.
• 53. Schmidt HM, Lanz U (2004) Surgical anatomy of the hand. Thieme, Stuttgart, New York.
• 54. Singer E (1933) Embriological pattern persisting in the arteries of the arm. Anat Rec, 55: 403–409.
• 55. Srivastava SK, Pande BS (1990) Anomalous pattern of median artery in the forearm of Indians. Acta Anat, 138: 193–194.
• 56. Standring S (2005) Gray’s anatomy. 39th ed. Churchill Livingstone, London.
• 57. Tollan CJ, Sivarajan V (2008) A persisting median artery in a patient with symbrachydactyly and carpal tunnel syndrome. Plast Reconstr Surg, 61: 819–821.
• 58. Toranto IR (1989) Aneurysm of the median artery causing recurrent carpal tunnel syndrome and anatomic review. Plast Reconstr Surg, 84: 510–512.
• 59. Tsuruo Y, Ueyama T, Ito T, Nanjo S, Gyoubu H, Satoh K, Iida Y, Nakai S (2006) Persistent median artery in the hand: a report with a brief review of the literature. Anat Sci Int, 81: 242–252.
• 60. Varley I, Wales CJ, Carter LM (2008) The median artery: its potential implications for the radial forearm flap. J Plast Reconstr Aesthet Surg, 61: 693–695.
• 61. Vollala VR, Nagabhooshana S, Bhat SM, Potu BK, Rakesh V (2008) Multiple accessory structures in the upper limb of a single cadaver. Singapore Med J, 49: 254–258.
• 62. Vollala VR, Nagabhooshana S, Bhat SM, Potu BK, Rodrigues V, Pamidi N (2009) Multiple arterial, neural and muscular variations in upper limb of a single cadaver. Rom J Morphol Embryol, 50: 129–135.