Acute carpal tunnel syndrome from thrombosed persistent median artery in a patient with congenitally absent radial artery.

Abstract

Thrombosis of the persistent median artery (PMA) is a rare cause of acute carpal tunnel syndrome (ACTS). Existence of a congenitally absent radial artery in this setting has not been described in the literature. Computed Tomography Angiography (CTA) and doppler screening were used in pre surgical planning. Open surgical decompression was achieved through the release of the flexor retinaculum in the left hand. A regimen of 100mg of Aspirin for 3months time was initiated to encourage clot resolution and recanalization of the thrombosed artery. The PMA was found to be abnormally large measuring approximately 4mm in diameter. Visible clotting off of the PMA in keeping with the doppler scans with maintenance of distal flow and was left intact with the hopes that it would recanalize over time. At the 3-month post-op review the antiplatelet therapy was ceased and the patient was symptom free, demonstrated no signs of ischaemia in the hand, and had returned to full functionality and physical activity. Although infrequently encountered, the knowledge of the anatomical variations of the forearm and hand together with doppler screening and CTA is essential to the surgical management of ACTS.