30 yo M. Both bone forearm fracture 8 years ago. Volar radial plate fixation. Struggling with hand paresthesias and symptoms over surgical site since.
He has a large persistent median artery without bifid nerve. The persistent median artery is just as large as the radial artery. I’ve certainly seen persistent median arteries, but most often tiny and between a bifid nerve. I’ve never seen one this big. Additionally, he has Tinel’s symptomatology as I scan the median nerve at the level of his volar scar. You can see the large persistent median artery cross over the median nerve, between the nerve and the overlying palmaris longus tendon (I hope the cine clip works). There are annotated images to follow the cine clip. Interestingly, he has symptoms over this spot of crossing, albeit somewhat inconsistent. The median nerve itself looks relatively normal to me. The persistent median artery is patent…no thrombus. No persistent median artery of the contralateral wrist.
I’m wondering if there is a vascular type compression effect related to the large persistent median artery? I forgot to ask patient if symptoms worsen with activity. Not sure how to tie it with the prior surgery, other than the anatomy/spacing being distorted from the surgery and volar plate. This is all a bit of a stretch, but thought it was potentially interesting.
Drew
