Sonographic Findings of the Bifid Median Nerve and Persistent Median Artery in Carpal Tunnel: A Preliminary Study in Chinese Individuals

OBJECTIVE: The aim of this study was to investigate the prevalence of anatomic variations of the bifid median nerve, persistent median artery and persistent median vein in Chinese individuals and their relationship with carpal tunnel syndrome. METHODS: One hundred and sixty median nerves were examined using ultrasonography and colour Doppler ultrasonography. The location, shape, and size of the bifid median nerve, persistent median artery and persistent median vein were recorded. The cross-sectional area of the bifid median nerve (two trunks) was measured at the level of the pisiform. RESULTS: Among the 160 wrists examined, a bifid median nerve was observed in 15 (9.4%) wrists, and a persistent median artery was observed in 12 (7.5%) wrists. These two variations either coexisted or were observed independently, and the probability of coexistence (6.3%) was higher than the probability of existing independently (bifid median nerve only 3.1%, persistent median artery only 1.3%). The cross-sectional area of the radial trunk was greater than (13 in 15, 86.7%) the cross-sectional area of the ulnaris trunk. Persistent median vein was observed in 9 wrists (5.6%). CONCLUSIONS: The persistent median artery and bifid median nerve tend to coexist, and the persistent median vein sometimes runs parallel to the persistent median artery. Their positional relationship in carpal tunnel is uncertain, and thus, preoperative ultrasound is necessary. These three variations do not present any additional risk for the development of carpal tunnel syndrome.

Anatomical Snuffbox and it Clinical Significance: A Literature Review / La Tabaquera Anatómica y su Importancia Clínica: Una Revisión de la Literatura

The anatomical snuffbox is a small triangular area situated in the radial part of the wrist, often used to perform clinical and surgical procedures. Despite the frequency with which this area is used, there is scarce information in literature about its details. The objective of this study is detailed knowledge of the anatomical snuffbox's anatomy and its components, the reported alterations at this portion, besides the clinical uses and significance of this area.

La tabaquera anatómica, es una pequeña área triangular ubicada en la parte radial de la muñeca utilizada a menudo para realizar procedimientos clínicos y quirúrgicos. A pesar de la frecuencia con la que se utiliza esta zona, escasea la información acerca de sus detalles en la literatura. El objetivo de este estudio es conocer con detalle la anatomía de la tabaquera anatómica y sus componentes, las alteraciones reportadas a ese nivel, y los usos e importancia clínica de esta región.

Flexor zone 5 cut injuries: emergency management and outcome

To determine the outcome and devise a protocol for emergency management of cut injuries in Flexor Zone 5 of hands. Descriptive study. Department of Plastic Surgery and Burn Unit, Mayo Hospital, KEMU, Lahore, Pakistan, from January 2009 to March 2013. All patients above 12 years of age with single sharp cut injuries in Flexor Zone 5, with no skeletal injuries, presenting within 12 hours in emergency were included with follow-up of 6 months, with active range of motion evaluated by Strickland's adjusted formula. Power of opponens pollicis and adductor muscles was evaluated from P0-4. Nerve repair results were evaluated serially by advancing Tinnel's sign, electrophysiological studies and sensory perception scored from S0-4 compared to the normal opposite upper limb. The study group comprised of 31 patients [M: F = 2.4: 1]. Average age was 27 years ranging from 17 - 53 years. In 25 [80%] cases, injury was accidental, in 3 [10%] homicidal and in 3 [10%] injury was suicidal. Four most commonly involved structures included Flexor carpi ulnaris, ulnar artery, ulnar nerve and Flexor digitorum superficialis. Median nerve and radial artery were involved in 10 cases each, while ulnar artery and ulnar nerve were involved in 14 cases each. Longtendons were involved in most cases with greater involvement of medial tendons. None of the patients required re-exploration for ischaemia of distal limb while doppler showed 22 out of 24 vascular anastomosis remained patent. Recovery of long-tendons was good and recovery after nerve repair was comparable in both median and ulnar nerves. Early and technically proper evaluation, exploration and repair of Zone 5 Flexor tendon injuries results in good functional and technical outcome

Arteria mediana persistente (AMP) bilateral de gran calibre en sujeto asintomático / High-caliber persistent bilateral median artery in asymptomatic

Se describe hallazgo en hombre de 22 años, asintomático, sano, de Arteria Mediana Persistente (AMP) bilateral de gran calibre asociada a un nervio median bífido (NMB) en una de las muñecas. La arteria mediana puede persistir hasta la adultez, acompañando al nervio por el túnel carpiano. Es una variante frecuente, suele ser bilateral y se asocia usualmente a NMB. La presencia de AMP puede asociarse a STC agudo secundario a trombosis y a STC crónicos por conflicto espacial. Sorprende el carácter asintomático de nuestro paciente a pesar del gran calibre de sus AMP. Sugerimos realizar, previo a cirugía o infiltración por STC, una ultrasonografía para adaptar tratamiento y evitar complicaciones.

We describe two high-caliber persistent median arteries (MPA) in an asymptomatic 22 year old healthy man, one of them between a bifid median nerve (BMN). The median artery may persist into adulthood, accompanying the median nerve through the carpal tunnel. It is a frequent anatomic variant, usually bilateral, regularly associated to BMN. The presence of MPA may be associated with acute carpal tunnel syndrome (CTS) secondary to thrombosis and chronic CTS probably due to spatial conflict. In this case, calls attention the lack of symptomatology despite the great size of MPA. We suggest performing prior to any surgery or infiltration of corticosteroids for CTS, an ultrasonographic study to avoid surgical complications.