CC BY 4.0 · Rev Bras Ortop (Sao Paulo)
DOI: 10.1055/s-0044-1785657
Artigo Original

Persistent Median Artery and Carpal Tunnel Syndrome: A Retrospective Study

Article in several languages: português | English
Yago de Andrade Fonseca Felix
1   Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
,
Vitor Henrique de Lima Pistilli
1   Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
,
1   Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
,
Filipe Jun Shimaoka
1   Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
,
Luiz Garcia Mandarano-Filho
1   Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
,
Nilton Mazzer
1   Departamento de Ortopedia e Anestesiologia, Hospital das Clínicas, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
› Author Affiliations

Abstract

Objective This study presents a retrospective study of persistent median artery associated with carpal tunnel syndrome (CTS).

Methods A retrospective study of the persistent median artery and CTS. Exclusion criteria were patients who did not present persistent median artery, those who were diabetic, or had rheumatoid diseases, and those who decided not to do the surgery. Only 25 patients were eligible for this retrospective study.

Results Median artery thrombosis had statistical differences considering the variables sex (p = 0.009), electroneuromyography findings (p = 0.021), profession (p = 0.066), and “total duration since the beginning of the symptoms” (p = 0.055). Thenar muscle atrophy had no statistical differences when compared to the variables. Bifid median nerve had statistical differences when compared to provocative tests (p = 0.013), frequency of symptoms (p = 0.001), and age (p = 0.028).

Conclusion Although uncommon, the persistent median artery should be considered a differential diagnosis for CTS. Ultrasonography is a reliable method to predict carpal tunnel anatomy. Late onset and symptoms could influence artery thrombosis and worsen the symptoms.

Financial Support

The author(s) received no financial support for the research, authorship, and/or publication of this article.


Work developed at the Department of Orthopedics and Anesthesiology of the Hospital of Clinics of the Ribeirao Preto Medical School of University of São Paulo, Ribeirão Preto, SP, Brazil.




Publication History

Received: 26 June 2022

Accepted: 18 January 2023

Article published online:
13 May 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 
  • Referências

  • 1 Atroshi I, Gummesson C, Johnsson R, Ornstein E, Ranstam J, Rosén I. Prevalence of carpal tunnel syndrome in a general population. JAMA 1999; 282 (02) 153-158
  • 2 Abdouni YA, Brunelli JPF, Munia MAS. Síndrome do túnel do carpo aguda por trombose da arte mediana: relato de caso [Published online: 2020-09-25]. Rev Bras Ortop Available from: https://www.thieme-connect.com/products/ejournals/abstract/10.1055/s-0040-1714228?articleLanguage=pt
  • 3 Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 2014; 49 (05) 429-436
  • 4 Paget J. The first description of carpal tunnel syndrome. J Hand Surg Eur Vol 2007; 32 (02) 195-197
  • 5 Severo A, Ayzemberg H, Pitágoras T, Nicolodi D, Mentz L, Lech O. Carpal tunnel syndrome – Analysis of 146 cases treated by “mini-open” technique. Rev Bras Ortop 2001; 36 (09) 330-335
  • 6 Oliveira Filho JR, Oliveira ACR. Carpal tunnel syndrome in labor field. Rev Bras Med Trab 2017; 15 (02) 182-192
  • 7 Mazer N, Barbieri CH, Zatiti SCA, Velludo MAL. Síndrome do túnel carpal aguda associada a trombose da artéria mediana persistente. Rev Bras Ortop 1993; 28 (04) 201-203
  • 8 Schubert R. [Thrombosis of persistent median artery in the carpal tunnel–diagnosis with MRI and contrast enhanced MR angiography]. Röfo Fortschr Geb Röntgenstr Neuen Bildgeb Verfahr 2008; 180 (09) 836-838
  • 9 Carry PM, Nguyen AK, Merritt GR. et al. Prevalence of Persistent Median Arteries in the Pediatric Population on Ultrasonography. J Ultrasound Med 2018; 37 (09) 2235-2242
  • 10 Nayak SR, Krishnamurthy A, Kumar SM. et al. Palmar type of median artery as a source of superficial palmar arch: a cadaveric study with its clinical significance. Hand (N Y) 2010; 5 (01) 31-36
  • 11 Rodríguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo JR. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat 2001; 199 (Pt 5): 547-566
  • 12 Vegas R, Jesús M, Alonso R, Elena M, Miguelez Sierra P. Arteria mediana persistente: una variación anatómica vascular en el miembro superior. Estudio anatómico, revisión bibliográfica y estudio clínico en 128 pacientes. Cir Plast Ibero-Latinoam 2020; 45 (04) 427-434
  • 13 Barfred T, Højlund AP, Bertheussen K. Median artery in carpal tunnel syndrome. J Hand Surg Am 1985; 10 (6 Pt 1): 864-867
  • 14 Avenel M, Miranda S, Benhamou Y. et al. [Acute carpal tunnel syndrome caused by a thrombosis of a persistent median artery: 2 case reports]. Rev Med Interne 2019; 40 (07) 453-456
  • 15 Kele H, Verheggen R, Reimers CD. Carpal tunnel syndrome caused by thrombosis of the median artery: the importance of high-resolution ultrasonography for diagnosis. Case report. J Neurosurg 2002; 97 (02) 471-473
  • 16 Gassner EM, Schocke M, Peer S, Schwabegger A, Jaschke W, Bodner G. Persistent median artery in the carpal tunnel: color Doppler ultrasonographic findings. J Ultrasound Med 2002; 21 (04) 455-461
  • 17 Feintisch AM, Ayyala HS, Datiashvili R. An Anatomic Variant of Persistent Median Artery in Association with Carpal Tunnel Syndrome: Case Report and Review of the Literature. J Hand Surg Asian Pac Vol 2017; 22 (04) 523-525
  • 18 Pimentel VS, Artoni BB, Faloppa F, Belloti JC, Tamaoki MJS, Pimentel BFR. Prevalência de variações anatômicas encontradas em pacientes com síndrome do túnel do carpo submetidos a liberação cirúrgica por via aberta clássica. Rev Bras Ortop 2022; 57 (04) 636-641
  • 19 Solewski B, Lis M, Pękala JR. et al. The persistent median artery and its vascular patterns: A meta-analysis of 10,394 subjects. Clin Anat 2021; 34 (08) 1173-1185
  • 20 Saenz C, Rahimi OB, Kar R. Cadaveric study of division of the median nerve by the persistent median artery. Surg Radiol Anat 2022; 44 (11) 1455-1460
  • 21 Lucas T, Kumaratilake J, Henneberg M. Recently increased prevalence of the human median artery of the forearm: A microevolutionary change. J Anat 2020; 237 (04) 623-631