Purpose
Variations of median nerve course are of interest to radiologists,
neurologists and mainly hand surgeons. We herein aimed to study the anatomical variations of median nerve in the hand and their frequency in a group of patients diagnosed with carpal tunnel syndrome (CTS).
Methods and Materials
Sixty three subjects (47 women; mean age 56 years) with bilateral (47) and unilateral (15) clinically overt and electrophysiologically proven idiopathic carpal tunnel syndrome were included in the study.Based on ultrasonographic imaging,
median nerves were divided into 3 subgroups: single nerve; bifid with widely separated branches; bifid with a very thin septum between the two branches. /p>
Results
We found 80 single and 28 bifid median nerves in 109 wrists with CTS.
Eight patients had bilateral bifid nerve and 11 unilateral.
Eight bifid (1 bilateral) nerves had widely separated branches and 19 (5 bilateral) had branches close together or attached to each other.
Two women with bilateral bifid nerve had both variations ple-converted-space>Based on ultrasonographic imaging,
median nerves were divided into 3 subgroups: single nerve; bifid with widely separated branches; bifid with a very thin septum between the two branches. /p>
Conclusion
Median nerve morphology’s variations are not uncommon amongst CTS patients.
Inadvertent injury or ignorance of one branch in case of a bifid nerve during surgical release of the transverse carpal ligament can lead to a poor outcome of the procedure and failure in releasing patient’s symptoms.
We conclude than since the anatomical variability of median nerve can be easily detected on ultrasonography,
it is essential that this should be mentioned in the radiologist's report.
References
Walker F.
et al.
Prevalence Of Bifid Median Nerves And Persistent Median Arteries And Their Association With Carpal Tunnel Syndrome In A Sample Of Latino Poultry Processors And Other Manual Workers.
Muscle Nerve 48: 539–544,
2013
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.
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...
Personal Information
Radiology Department,
University Hospital of Patras,
Greece
Neurology Departmant,
University Hospital of Patras,
Greece