Document Type

Article

Publication Date

9-2016

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This article has been peer reviewed. It is the author’s final published version in International Journal of Morphology

Volume 34, Issue 3, September 2016, Pages 997-1001.

The published version is available at DOI: 10.4067/S0717-95022016000300030 Copyright © Universidad de la Frontera

Abstract

We report the association of a persistent median artery, a bifid median nerve with a rare very high origin palmar cutaneous branch, presenting bilaterally in the upper limb of a 75-year-old female cadaver. The persistent median nerve with a bifid median nerve has been reported in patients presenting with carpal tunnel syndrome. Reports of this neurovascular anomaly occurring in association with a high origin palmar cutaneous branch however, are few. This subset of patients is at risk of inadvertent nerve transection during forearm and wrist surgery. Pre-operative magnetic resonance imaging (MRI) and high resolution sonography (HRS) can be used to screen this triad. MRI can reveal if the patient’s disability is associated with a persistent median nerve, a bifid median nerve. HRS can help identify a palmar cutaneous branch of the median nerve that arises in an unexpected high forearm location. Such knowledge will help surgeons in selecting the most appropriate surgical procedure, and help avoid inadvertent injury to cutaneous nerves arising in unexpected locations. In patients presenting with a bilateral carpal tunnel syndrome, hand surgeons should consider very high on the list of differential diagnosis a persistent median artery with a concomitant bifid median nerve, with a high suspicion of a possible bilateral occurrence of a bilaterally high arising palmar cutaneous branch of the median nerve. © 2016, Universidad de la Frontera. All rights reserved.

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This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 License

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