Persistent median artery of the forearm

Last revised by Dr Mostafa El-Feky on 14 Oct 2020

The persistent median artery of the forearm is an accessory artery that arises from the ulnar artery in the proximal forearm and is a persistent embryological remnant of the axial artery that usually regresses by eight weeks gestation.

It is present in ~10% (range 2.2-23%) of the population.

The persistent median artery of the forearm is a continuation of the common or anterior interosseous artery and accompanies the median nerve as it passes through the forearm and carpal tunnel

It is unilateral ~67% of the time and is associated with anomalous median nerves ~70% (range 63-80%) of the time - most commonly bifid median nerves followed by high division of the median nerve. The persistent median artery is contained within the epineurium of the normal or bifid median nerve. 

The persistent median artery is located on the ulnar aspect of the normal median nerve (see Case 1) but if the median nerve is bifid the persistent median artery is located between the two nerve bundles (see Case 2). 

The persistent median artery can be a cause of carpal tunnel syndrome and is important to recognize if imaging is performed pre-operatively as it may be damaged during surgery. If it is not recognized intra-operatively due to tourniquet use subsequent damage may be a cause of post-operative bleeding. 

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Cases and figures

  • Case 1: bilateral persistent median artery of the forearm
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  • Case 2: bifid median nerve and persistent median artery
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  • Case 3 : thrombosis in artery
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  • Case 4: with bifid median nerve
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  • Case 5: with bifid median nerve
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