Abstract
Introduction: Carpal tunnel syndrome is the entrapment neuropathy of median nerve at wrist. Bifid median nerve is a variation in the normal anatomy and can be associated with carpal tunnel syndrome. We aim to study the prevalence of bifid median nerve in patients with moderate to severe carpal tunnel syndrome.
Methods: An observational study was done in 74 patients with moderate to severe carpal tunnel syndrome for anatomic variations in the median nerve. The ultrasound evaluation of the wrist was performed in all patients. The datas were statistically analysed.
Results: The bifid median nerve was present in 12.2% and persistent median artery in 4.1% of the patients.
Conclusion: The bifid median is relatively common in patients with CTS. The ultrasound evaluation of the carpal tunnel is recommended in all patients with CTS.
Keywords: Carpal tunnel syndrome, bifid median nerve, persistent median artery.
References
- Alfonso C, Jann S, Massa R, Torreggiani A. Diagnosis, treatment and follow-up of the carpal tunnel syndrome: a review. Neurolog Sci 2010; 31(3): 243-52
- Lanz U. Anatomical variations of the median nerve in the carpal tunnel. J Hand Surg [Am] 1977; 2:44–53.
- Bayrak IK, Bayrak AO, Kale M, Turker H, Diren B. Bifid median nerve in patients with carpal tunnel syndrome. J Ultrasound Med. 2008; 27:1129–1136. [PubMed: 18645070]
- Fernandez-Garcia S, Pi-Folguera J, Estallo-Marino F: Bifid median nerve compression due to a musculotendinous anomaly of FDS to the middle finger. J Hand Surg [Br] 19:616, 1994
- Schultz RJ, Endler PM, Deneys Huddleston H:Anomalous median nerve and an anomalous muscle belly of the first lumbrical associated with carpal-tunnel syndrome. J Bone Joint Surg [Am] 55:1744, 1973
- Naranjo A, Ojeda S, Mendoza D, Francisco F, Quevedo Jc, Erausquin C: What is the diagnostic value of ultrasonography compared to physical evaluation in patients with idiopathic carpal tunnel syndrome? Clin Exp Rheumatol 2007; 25: 853-9
- Presazzi A, Bortolotto C, Zacchino M, Madonia L, Draghi F. Carpal tunnel: Normal anatomy, anatomical variants and ultrasound technique. Journal of ultrasound. 2011 Mar 31;14(1):40-6
- Dawson DM. Entrapment neuropathies of the upper extremities. New England Journal of Medicine. 1993 Dec 30;329(27):2013-8.
- Pierre-Jerome C, Smitson RD Jr, Shah RK, Moncayo V, Abdelnoor M, Terk MR. MRI of the median nerve and median artery in the carpal tunnel: prevalence of their anatomical variations and clinical significance. Surg Radiol Anat. 2010; 32:315–322. [PubMed: 20033168]
- Granata G, Caliandro P, Pazzaglia C, Minciotti I, Russo G, Martinoli C, et al. Prevalence of bifid median nerve at wrist assessed through ultrasound. Neurol Sci. 2011; 32:615–618. [PubMed: 21533564]
- Lannicelli E, Chianta GA, Salvini V, Almberger M, Monacelli G, Passariello R. Evaluation of bifid median nerve with sonography and MR imaging. J Ultrasound Med. 2000; 19:481–485. [PubMed: 10898302]
- Padua L, Liotta G, Di Pasquale A, Granata G, Pazzaglia C, Caliandro P, et al. Contribution of ultrasound in the assessment of nerve diseases. Eur J Neurol. 2012; 19:47–54. [PubMed: 21554493]
- Chen SF, Huang CR, Tsai NW, Chang CC, Lu CH, Chuang YC, et al. Ultrasonographic assessment of carpal tunnel syndrome of mild and moderate severity in diabetic patients by using an 8-point measurement of median nerve cross-sectional areas.BMC Med Imaging. 2012;12:15.
Corresponding Author
Dr Sreejith Kalathummarath
Associate Professor, Department of Physical Medicine and Rehabilitation,
Government Medical College, Kozhikode 673008
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i10.194
