Anesth Pain Med.  2020 Apr;15(2):193-198. 10.17085/apm.2020.15.2.193.

Carpal tunnel syndrome caused by thrombosed persistent median artery - A case report -

• Jeon SY
• Lee K
• Yang WJ

• KMID: 2500971
• DOI: http://doi.org/10.17085/apm.2020.15.2.193

Abstract

A rare case of carpal tunnel syndrome caused by a thrombosed persistent median artery is presented here. The diagnosis was delayed due to the overlapping cervical radiculopathy. Acute severe pain and nocturnal paresthesia were chief complaints. Ultrasonography, magnetic resonance imaging, and computed tomography angiography revealed that the median nerve was compressed by the occluded median artery. Instead of surgery, conservative therapy was tried. It worked well for six months. The importance of using modalities for decision making of diagnosis and treatment is emphasized in this report.

Keyword

Carpal tunnel syndrome; Computed tomography angiography; Persistent median artery; Thrombosis

Figure

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  Fig. 1. Transverse and sagittal images at the level of C5-6 of the cervical computed tomography show that the disc is bulging mildly and the right uncovertebral joint is prominent without significant foraminal narrowing.

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  Fig. 2. Ultrasonogram of the thrombosed persistent median artery (dotted circle) and the compressed median nerve (arrow) in the patient’s right proximal (prox) carpal tunnel.

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  Fig. 3. Longitudinal doppler ultrasonogram of the patient’s right persistent median artery (PMA).

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  Fig. 4. Persistent median artery in carpal tunnel. Axial gadolinium-enhanced spin-echo T1-weighted magnetic resonance images at levels of pisiform (A) and hook of hamate (B) show persistent median artery (arrow) and two small veins in the carpal tunnel located at volar aspect of median nerve (arrowhead), causing mild impingement of median nerve.

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  Fig. 5. 3D computed tomography angiogram of the patient’s right upper extremity. Each persistent median artery (arrow) and radial artery (arrowhead) are originated from each brachial artery and axillary artery, respectively.

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  Fig. 6. Computed tomography angiograms of the right upper extremity at levels of hook of hamate (A) in which the persistent median artery (PMA) (arrow) is occluded and base of metacarpal bones (B) in which the PMA’s flow is reconstituted by palmar collaterals.

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