The persistent median artery: A new challenger in carpal tunnel imaging?

Introduction: The aim of the study was to determine the incidence of the persistent median artery (PMA) at the wrist level, its correlation to age, gender, and contralateral wrist, and its position to the median nerve and its variations. Material and Methods: A total of 1504 wrists were evaluated using the magnetic resonance imaging examination. The proton density and T2-weighted axial images were investigated. The patients were divided into three groups according to age. The incidence of PMA, gender, and relationship with the contralateral wrist, distribution according to the age groups, and position to the median nerve were recorded. The images were first evaluated on the consensus of two radiologists and then all data were inspected by another radiologist with at least 10 years of experience in musculoskeletal radiology. Results: Palmar-type PMA was observed in 379 of 1504 included wrists (25.1%). The evaluation according to the age groups showed that the incidence of PMA decreased with increasing age. The median nerve variations concomitant to PMA (bifid-trifid) was found to be seen in 94 patients. In 61 of these 94 patients (64.8%), PMA was passing through the branches of the median nerve. It was observed that in 62.5% of the cases, PMA occupied an anteromedial position to the median nerve. Discussion and Conclusion: PMA accompanied by median nerve variations is frequently seen. The incidence of PMA decreases with increasing age. The presence of PMA and its position should be cautiously evaluated using imagery, particularly in young patients before wrist surgery.