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Carpal Tunnel Syndrome caused by High Division of the Median Nerve (a bifid median nerve) Proximal to the Carpal Tunnel, A Case Report
Yeo-song Kim1, Hak-cheol Ko1, Byung-chul Son1
Correspondence  Byung-chul Son ,Tel: 010-8938-7485, Fax: 02-594-4248, Email: sbc@catholic.ac.kr
Received: February 9, 2018;  Accepted: March 22, 2018.  Published online: March 22, 2018.
ABSTRACT
High division of the median nerve proximal to the carpal tunnel (known as a bifid median nerve) is a median nerve anomaly with incidence rate of 2.8%. This rare entity is often associated with persistent median artery, aberrant muscles, and carpal tunnel syndrome (CTS). Bifid median nerve is a cause of secondary carpal tunnel syndrome due to its relatively higher cross-sectional area compared to a nonbifid median nerve. We report a case of median nerve entrapment at the left wrist associated with bifid median nerve and ramification of a persistent median artery. A 69-year-old, right-handed woman, without noticeable medical history, presented chronic paresthesia in her left hand and fingers with duration of two years. MRI of the left wrist showed a swollen, enlarged bifid median nerve proximal to the flexor retinaculum. Magnetic resonance imaging (MRI) revealed a typical bifid median nerve proximal to the carpal tunnel. Decompression of the median nerve was carefully performed with extended forearm incision. Median nerve variation should be considered when performing open or endoscopic carpal tunnel release to prevent iatrogenic injuries.
Key words: Bifid median nerve ; Carpal tunnel syndrome ; Congenital abnormalities ; Magnetic resonance imaging; Median nerve ; Persistent median artery
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