Large patent median arteries and their relation to the superficial palmar arch with respect to history, size consideration and clinic consequences (original) (raw)
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Surg Radiol Anatomy, 2008
Background A large patent median artery can be involved in several clinical disorders like carpal tunnel syndrome, anterior interosseous nerve syndrome and pronator syndrome. Methods The frequency and variability in the expression of the median artery and the expression of the other forearm arteries were recorded during two dissection courses. The topography of the arteries with their ramiWcations was documented on diagrams and photographs. The outer diameters of forearm arteries were measured. Results A large median artery was found in 4 of 54 arms (7.4%). The median arteries took their origin from the ulnar artery or the common interosseous artery. In one case, the median artery pierced the median nerve in its course under the pronator teres. The outer diameters of the median arteries varied between 1.5 and 2.0 mm proximally and 1.5 and 2.0 mm distally. The diameters of the radial arteries varied between 3.0 and 5.5 mm proximally and 3.0 and 4.0 mm distally and were not reduced in any of the four cases with a large median artery. Conclusions Surgeons should be aware of other variations in the forearm when a persistent median artery is iden-tiWed, for example high median nerve bifurcations. Furthermore, it should be kept in mind that additional structures leading to nerve compression may be present in the carpal tunnel.
Persistent median artery inside the carpal tunnel: description and surgical implications
Autopsy and Case Reports
The median artery is usually a transient vessel during the embryonic period. However, this artery can persist in adult life as the persistent median artery. This paper aims to describe this relevant anatomical variation for surgeons, review the literature and discuss its clinical implications. A routine dissection was performed in the upper left limb of a male adult cadaver of approximately 50-60 years of age, embalmed in formalin 10%. The persistent median artery was identified emerging as a terminal branch of the common interosseous artery with a path along the ulnar side of the median nerve. In the wrist, the persistent median artery passed through the carpal tunnel, deep in the transverse carpal ligament. The dissection in the palmar region revealed no anastomosis with the ulnar artery forming the superficial palmar arch. The common digital arteries emerged from the ulnar artery and the persistent median artery. Such variation has clinical and surgical relevance in approaching carpal tunnel syndrome and other clinical disorders in the wrist.
Conservative treatment for Carpal Tunnel Syndrome caused by persistent median artery: a case report
Research, Society and Development, 2021
Knowledge of a persistent median artery, defined as an anatomical vascular variation, is of clinical importance because it can be an unusual etiology of carpal tunnel syndrome. This report describes the case of a 42-year-old female patient with acute pain and paresthesia involving the volar aspect of the first, second, and third fingers of the left hand. The clinical manifestations pointed to compressive neuropathy of the median nerve, and diagnostic imaging showed anatomical vascular variation. Details were collected through interviews with the patient, and photographic records of imaging exams were thoroughly analyzed. This case study shows the importance of the identification and knowledge about anatomical variations considering that under specific pathological conditions, they can be a cause of clinical syndromes. Such knowledge is also important in the field of surgery for the prevention of iatrogenic injuries.
HAND, 2009
The superficial palmar arch (SPA) and its contributing arteries are highly variable. The palmar type of median artery (PMA) can be involved in the formation of the SPA by replacing the superficial palmar branch of the radial artery (RA) or the ulnar artery (UA). The present study was undertaken to investigate the presence of the PMA and its contribution in the formation of SPA in 42 cadavers (84 upper limbs) of Indian origin. When there was a PMA, its outer diameter was measured in the carpal tunnel. The PMA was found in 13 upper limbs (15.4%), and of these ten incidences (11.9%), the PMA took part in the formation of SPA, and in three instances (3.5%), the PMA did not make up part of the SPA. Out of the ten cases in which the PMA contributed to the formation of SPA, in six cases (7.1%), the PMA anastomosed with the UA; in three cases (3.5%), the PMA anastomosed with both the UA and the RA, and in one incidence (1.1%), the PMA joined the arteria radialis indicis (deep branch of the RA) to complete the SPA. The outer diameters of the median arteries varied between 0.8 and 2.6 mm with the mean value of 1.7 mm. The present study concludes that the median-ulnar type of SPA was the most common type of SPA when the PMA was encountered as a source of superficial arterial arcade of the hand, followed by the radial-median-ulnar type. The vascular patterns found in this study are important to hand surgeons. The present study of PMA origin, course, and its contribution to the SPA will add to the existing knowledge of the vascular anatomy of forearm and hand.
Persistent median artery in the carpal tunnel and anastomosis with superficial palmar arch
Case Reports in Plastic Surgery and Hand Surgery, 2016
Persistent median artery (PMA) in present cadaver originated from the brachial artery and anastomosed with the superficial palmar arch (SPA). As the PMA may be the cause of carpal tunnel syndrome and SPA is the main source of arterial supply, knowledge of which are important for the hand surgical interventions.
Italian journal of anatomy and embryology = Archivio italiano di anatomia ed embriologia, 2016
The median artery is the axis artery of forearm till the 811 week of gestation and thereafter nor- mally regresses, only its proximal part remaining patent as the companion artery of the medi- an nerve in adults. A large, well developed persistent median artery extended to the palm and contributed to its vascular supply in 6 out of 100 upper limbs dissected. Dissection was used to demonstrate the persistent median arteries from their origin to termination. The persistent median artery originated from the ulnar artery in the cubital fossa. It pierced the median nerve, descended anterior t4 the nerve'in a common sheath and passed deep to the flexor retinaculum. An accessory head of flexor pollicis longus, which is a usual finding associated with the persis- tent median artery, was seen in one forearm. The superficial palmar arch was not seen in any specimen with persistent median artery. In all the specimens with persistent median artery, the lateral half of the palm and lateral 2...
Persistent median artery: Cadaveric study and review of the literature
Clinical Anatomy, 2011
The persistent median artery (PMA) may compress the median nerve (MN) and may be a significant supply of blood to the hand. Two cases of unilateral PMA (4%) were detected during the dissection of 50 upper limbs. The first case was a 75-year-old, right-handed male who suffered from chronic pain in both upper limbs, especially the left side. A dissection of his left upper limb revealed a PMA piercing both the MN and the medial branch of the anterior interosseous nerve. This artery coursed distally, deep to the transverse carpal ligament (TCL), forming a median-ulnar pattern for the superficial palmar arch (SPA). The PMA was superficial to two nerves at the distal edge of the TCL; the extraligamentous recurrent thenar (RT) branch of the MN and the third common digital nerve (TCDN). The second case was from the left side of an 80-year-old female found to have a high origin of the radial artery with trifurcation of the latter into PMA, common interosseous, and ulnar arteries. The PMA passed deep to the TCL forming a radial-median-ulnar pattern of SPA. Both the transligamentous RT branch of the MN and the TCDN passed deep to the PMA inside the carpal tunnel, before the abnormal crossing of the latter nerve ventral to the SPA on its way to the digits. The relationships of the PMA to various MN branches may have important implications regarding the diagnosis and treatment of MN compressive neuropathies.
Bilateral palmar type of persistent median artery: A case report
Indian journal of clinical anatomy and physiology, 2024
The persistent median artery (PMA) is an example of a supernumerary artery in the forearm. During embryonic development, the median artery regresses as the ulnar and radial arteries take over the blood supply of the forearm. Non-regression of the median artery will lead to its persistence into adulthood. We are reporting a bilateral presence of a palmar type of PMA, which was a branch of the ulnar artery, and the PMA passed through the carpal tunnel to supply the hand. On the right side, PMA pierced the median nerve in the upper forearm. In the palm, PMA did not form the superficial palmar arch. However, a communicating twig between the PMA and ulnar artery was observed on the left side. The presence of PMA could cause compression of the median nerve, leading to carpal tunnel syndrome. PMA of larger calibre could be used as a graft and in harvesting reconstructive free flap. Knowledge about these vascular variations is important in diagnosing nerve compression syndromes and avoiding unanticipated surgical complications. This is an Open Access (OA) journal, and articles are distributed under the terms of the Creative Commons AttribFution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
Anomalous median nerve associated with persistent median artery
Journal of anatomy, 1994
A right human forearm showed persistence of the median artery in combination with anomalies of the median nerve and of the palmar circulation. The median nerve formed a ring enclosing the median artery, gave off its 3rd palmar digital branch in the forearm, and had a high palmar cutaneous nerve origin and a double thenar supply. The superficial palmar arch was incomplete. The median artery extended into the hand, providing the 2nd common palmar digital artery and the artery to the radial side of the index finger. It anastomosed with the radial artery in the 1st web space.
Journal of Anatomy, 1999
This study confirms that the median artery may persist in adult life in 2 different patterns, palmar and antebrachial, based on their vascular territory. The palmar type, which represents the embryonic pattern, is large, long and reaches the palm. The antebrachial type,which represents a partial regression of the embryonic artery is slender, short, and terminates before reaching the wrist. These 2 arterial patterns appear with a different incidence. The palmar pattern was studied in the whole sample (120 cadavers) and had an incidence of 20 %, being more frequent in females than in males (1.3 : 1), occurring unilaterally more often than bilaterally (4 : 1) and slightly more frequently on the right than on the left (1.1 : 1). The antebrachial pattern was studied in only 79 cadavers and had an incidence of 76 %, being more frequent in females than in males (1.6 : 1) ; it was commoner unilaterally than bilaterally (1.5 : 1) and was again slightly more prevalent on the right than on the left (1.2 : 1). The origin of the median artery was variable in both patterns. The palmar type most frequently arose from the caudal angle between the ulnar artery and its common interosseous trunk (59 %). The antebrachial pattern most frequently originated from the anterior interosseous artery (55 %). Other origins, for both patterns, were from the ulnar artery or from the common interosseous trunk. The median artery in the antebrachial pattern terminated in the upper third (74 %) or in the distal third of the forearm (26 %). However, the palmar pattern ended as the 1st, 2nd or 1st and 2nd common digital arteries (65 %) or joined the superficial palmar arch (35 %). The median artery passed either anterior (67 %) or posterior (25 %) to the anterior interosseous nerve. It pierced the median nerve in the upper third of the forearm in 41 % of cases with the palmar pattern and in none of the antebrachial cases. In 1 case the artery pierced both the anterior interosseous and median nerves.