Persistent median artery inside the carpal tunnel: description and surgical implications

Abstract

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.

Keywords: Anatomy, regional; Biological Variation, Individual; Carpal Tunnel Syndrome; Nerve Compression Syndromes.

Figure 1. Photographs of the case. A – Cubital fossa; B – Forearm presentation; C – Wrist presentation; D – Opened transverse carpal ligament: 1) radial artery; 2) radial recurrent artery; 3) ulnar artery; 4) common interosseous artery; 5) persistent median artery; 6) pronator teres muscle; 7) median nerve; 8) palmaris longus tendon; 9) transverse carpal ligament (flexor retinaculum); 10) flexor digitorum superficialis tendons; 11) flexor pollicis longus tendon; 12) radial artery in anastomosis with the common digital artery of the index finger; 13) common digital palmar artery from the persistent median artery; 14) common digital palmar arteries from the ulnar artery. Scale bar A) and D) are 3cm; B) and C) are 5cm.