Bifid median nerve

Last revised by Yoshi Yu on 2 Apr 2023

A bifid median nerve is an uncommon anatomical variation in the forearm and has an increased association with a persistent median artery 4.

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.

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. 

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.

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Cases and figures

  • Case 1 : bifid median nerve and persistent median artery
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  •  Case 2
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  •  Case 3
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  • Case 4
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