Bifid median nerve
Citation, DOI, disclosures and article data
At the time the article was created Charudutt Jayant Sambhaji had no recorded disclosures.
View Charudutt Jayant Sambhaji's current disclosuresAt the time the article was last revised Yoshi Yu had no financial relationships to ineligible companies to disclose.
View Yoshi Yu's current disclosuresA bifid median nerve is an uncommon anatomical variation in the forearm and has an increased association with a persistent median artery 4.
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Epidemiology
It has an incidence of 9-19% 4. A persistent median artery is present in approximately half of those with a bifid median nerve 4.
Gross anatomy
The median nerve usually divides into two or three branches after exiting the distal edge of the flexor retinaculum that covers the carpal tunnel. These subdivide into digital nerves that supply opposing sides of the digits. The median nerve may divide into two nerve bundles in the distal forearm and appear as a bifid median nerve in the carpal tunnel.
When present, the persistent median artery of the forearm lies in between the two nerve bundles. The artery and bifid nerve can be enclosed by a common epineurium.
Practical points
As the median artery can be easily detected on ultrasound, it is essential that this be mentioned in the radiologist's report to avoid inadvertent injury to the nerve and artery during surgical release of the transverse carpal ligament.
Quiz questions
References
- 1. Propeck T, Quinn T, Jacobson J, Paulino A, Habra G, Darian V. Sonography and MR Imaging of Bifid Median Nerve with Anatomic and Histologic Correlation. AJR Am J Roentgenol. 2000;175(6):1721-5. doi:10.2214/ajr.175.6.1751721 - Pubmed
- 2. Gassner E, Schocke M, Peer S, Schwabegger A, Jaschke W, Bodner G. Persistent Median Artery in the Carpal Tunnel: Color Doppler Ultrasonographic Findings. J Ultrasound Med. 2002;21(4):455-61. doi:10.7863/jum.2002.21.4.455 - Pubmed
- 3. Bayrak I, Bayrak A, Kale M, Turker H, Diren B. Bifid Median Nerve in Patients with Carpal Tunnel Syndrome. J Ultrasound Med. 2008;27(8):1129-36. doi:10.7863/jum.2008.27.8.1129 - Pubmed
- 4. Eyer B. Persistent Median Artery - Radsource. Radsource. Radsource
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