Abstract
Purpose
The purpose of this study is to characterize the division of the median nerve by the persistent median artery (PMA) and highlight the associated clinical implications. Penetration of the median nerve by the PMA is believed to cause compression of the median nerve and affect nerve conduction velocity. This paper explored whether the origin and the pattern of PMA dictate its ability to divide the median nerve.
Methods
Origin, and relationship of the PMA to the median nerve were documented in 60 cadavers donated to the Human Anatomy Program at UT Health San Antonio. Entire path of this artery was followed in the forearm and the hand.
Results
Twenty-five cases of a persistent median artery (PMA) were found in the upper limbs (20.83%; 25/120) of these donated cadavers. Most of the persistent median arteries originated from the ulnar artery (48%; 12/25) and the others originated either from the anterior interosseous artery (36%; 9/25) or from the common interosseous artery (16%; 4/25). Sixty percent (15/25) of the persistent median arteries penetrated and divided the median nerve in the forearm. Interestingly, all the persistent median arteries that originated from the ulnar artery (100%; 12/12) divided the median nerve in the forearm and a palmar type of PMA was found to be more likely to divide the median nerve.
Conclusion
Clinicians performing surgeries in the forearm and hand need to be aware of this anomaly and should screen patients for the presence of this artery prior to surgical intervention.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Availability of data and materials
The data that support the findings of this study are available from the corresponding author, Rekha Kar, upon reasonable request.
References
Acarturk TO, Tuncer U, Aydogan LB, Dalay AC (2008) Median artery arising from the radial artery: Its significance during harvest of a radial forearm free flap. J Plast Reconstr Aesthet Surg 61:e5–e8. https://doi.org/10.1016/j.bjps.2007.10.026
Ahn DS, Yoon ES, Koo SH, Park SH (2000) A prospective study of the anatomic variations of the median nerve in the carpal tunnel in Asians. Ann Plast Surg 44:282–287. https://doi.org/10.1097/00000637-200044030-00006
Barfred T, Hojlund AP, Bertheussen K (1985) Median artery in carpal tunnel syndrome. J Hand Surg 10A:864–867. https://doi.org/10.1016/s0363-5023(85)80163-5
Claassen H, Schmitt O, Wree A (2008) Large patent median arteries and their relation to the superficial palmar arch with respect to history, size consideration and clinic consequences. Surg Radiol Anat 30:57–63. https://doi.org/10.1007/s00276-007-0290-5
Coleman SS, Anson BJ (1961) Arterial patterns in the hand based upon a study of 650 specimens. Surg Gynecol Obstet 113:409–424
Eid N, Ito Y, Shibata MA, Otsuki Y (2011) Persistent median artery cadaveric study and review of the literature. Clin Anat 24:627–633. https://doi.org/10.1002/ca.21127
Gainor BJ, Jeffries JT (1987) Pronator syndrome associated with a persistent median artery. A case report. J Bone Joint Surg Am 69(2):303–304
Gassner EM, Schocke M, Peer S, Schwabegger A, Jaschke W, Bodner G (2002) Persistent median artery in the carpal tunnel: color doppler ultrasonographic findings. J Ultrasound Med 21:455–461. https://doi.org/10.7863/jum.2002.21.4.455
Henneberg M, George BJ (1992) High incidence of the median artery of the forearm in a sample of recent Southern African cadavers. J Anat 180:185–188
Jones NF, Ming NL (1988) Persistent median artery as a cause of pronator syndrome. J Hand Surg 13A:728–732. https://doi.org/10.1016/s0363-5023(88)80135-7
Lavey EB, Pearl RM (1981) Patent median artery as a cause of carpal tunnel syndrome. Ann Plast Surg 7(3):236–238
McCormack LJ, Cauldwell EW, Anson BJ (1953) Brachial and antebrachial arterial patterns. A study of 750 extremities. Surg Gynecol Obstet 96:43–54
Rodriguez-Niedenfuhr M, Sanudo JR, Vazquez T, Nearn L, Logan B, Parkin I (1999) Median artery revisited. J Anat 195:57–63. https://doi.org/10.1046/j.1469-7580.1999
Singer E (1933) Embryological pattern persisting in the arteries of the arm. Anat Rec 55:403–409
Singla RK, Kaur N, Dhiraj GS (2012) Prevalence of the Persistent median artery. J Clin Diagn Res 9:1454–1457. https://doi.org/10.7860/JCDR/2012/4218.2531
Srivastava SK, Pande BS (1990) Anomalous pattern of median artery in the forearm of Indians. Acta Anat 138:193–194. https://doi.org/10.1159/000146938
Acknowledgements
The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind’s overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude. We would also like to thank Dr. Wouter Koek for his assistance in statistical analysis.
Funding
No funding was received for conducting this study.
Author information
Authors and Affiliations
Contributions
CS, collected, analyzed, and drafted the manuscript. OB.R, analyzed and critically reviewed the manuscript. RK, conceptualized and designed this study, analyzed data, and finalized the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Conflict of interest
The authors have no relevant financial or non-financial interests to disclose.
Ethical approval
Body donors used in this study are willed to the Human Anatomy Program at the UT Health San Antonio. UT Health San Antonio is a member institution of the State Anatomical Board of Texas. All donations to the program are registered and cared for under the statutes and guidelines of the State of Texas. This study did not require IRB approval (Protocol Number: 20220574NHR).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Saenz, C., Rahimi, O.B. & Kar, R. Cadaveric study of division of the median nerve by the persistent median artery. Surg Radiol Anat 44, 1455–1460 (2022). https://doi.org/10.1007/s00276-022-03035-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-022-03035-1