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Sonography and MR Imaging of Bifid Median Nerve with Anatomic and Histologic Correlation

Tim Propeck1, Timothy J. Quinn1,2, Jon A. Jacobson1, Augusto F. G. Paulino3, Ghiyath Habra4 and Vigen B. Darian5

1 Department of Radiology, University of Michigan Medical Center, 1500 E. Medical Center Dr., TC-2910G, Ann Arbor, MI 48109-0326.
2 Toledo Radiologic Associates, Toledo Hospital, Toledo, OH 43528.
3 Department of Pathology, University of Michigan Medical Center, Ann Arbor, MI 48109-0326.
4 Department of Radiology, Henry Ford Hospital, 2799 W. Grand Blvd., Detroit, MI 48202-2689.
5 Department of Plastic and Hand Surgery, Henry Ford Hospital, Detroit, MI 48202-2689.



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  		Fig. 1A. —Illustration of median nerves. (Adapted from [5]) Normal median nerve (solid arrow). Note flexor retinaculum (open arrow).

 


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  		Fig. 1B. —Illustration of median nerves. (Adapted from [5]) Bifid median nerve (solid arrows) and persistent median artery (arrowhead). Note flexor retinaculum (open arrow).

 


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  		Fig. 2A. —16-year-old girl with carpal tunnel syndrome and bifid median nerve. Axial sonogram of abnormal wrist and asymptomatic contralateral wrist shows normal median nerve (curved arrow and "1") on left side (lt) and bifid median nerve (ulnar trunk = open arrows and "1," radial trunk = solid arrows and "2") on right side of image (rt). L = lunate.

 


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  		Fig. 2B. —16-year-old girl with carpal tunnel syndrome and bifid median nerve. Sagittal sonogram of abnormal wrist shows ulnar trunk (open arrows, between x's, "1") on left side of image and radial trunk (solid arrows, between +'s, "2") on right side of image of bifid median nerve. L = lunate. Note abnormal hypoechogenicity of median nerve and flexor retinaculum (arrowhead).

 


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  		Fig. 2C. —16-year-old girl with carpal tunnel syndrome and bifid median nerve. Intraoperative photograph of volar wrist shows ulnar trunk (open arrows) and radial trunk (solid arrows) of bifid median nerve.

 


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  		Fig. 3A. —Cadaveric wrist specimen from 70-year-old man with bifid median nerve. Axial sonogram of volar wrist shows ulnar trunk (open short arrows) and radial trunk (solid short arrows) of bifid median nerve. Note persistent median artery (long arrow). R = radius, t = flexor digitorum tendons.

 


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  		Fig. 3B. —Cadaveric wrist specimen from 70-year-old man with bifid median nerve. Sagittal sonogram of volar wrist (proximal is left, distal is right) shows radial trunk of bifid median nerve (solid short arrows). Note normal alternating hypoechoic and hyperechoic appearance of median nerve. (R = radius).

 


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  		Fig. 3C. —Cadaveric wrist specimen from 70-year-old man with bifid median nerve. Axial T1-weighted MR image shows ulnar trunk (open short arrow) and radial trunk (solid short arrow) of bifid median nerve. Note persistent median artery (long arrow). t = flexor digitorum tendons.

 


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  		Fig. 3D. —Cadaveric wrist specimen from 70-year-old man with bifid median nerve. Anatomic section of volar wrist shows ulnar trunk (open short arrows) and radial trunk (solid short arrows) of bifid median nerve. Note persistent median artery (long arrow). t = flexor digitorum tendons.

 


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  		Fig. 4A. —Cadaveric wrist specimen from 70-year-old woman with partially bifid median nerve. Axial sonogram of volar wrist shows bilobed appearance of partially bifid median nerve (arrows). t = flexor digitorum tendons, L = lunate.

 


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  		Fig. 4B. —Cadaveric wrist specimen from 70-year-old woman with partially bifid median nerve. Sagittal sonogram of volar wrist (proximal is left, distal is right) shows partially bifid median nerve (arrows). R = radius, L = lunate.

 


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  		Fig. 4C. —Cadaveric wrist specimen from 70-year-old woman with partially bifid median nerve. Axial T1-weighted MR image shows bilobed appearance of partially bifid median nerve (arrows). t = flexor digitorum tendons, L = lunate.

 


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  		Fig. 4D. —Cadaveric wrist specimen from 70-year-old woman with partially bifid median nerve. Anatomic section shows bilobed appearance of partially bifid median nerve (arrows). t = flexor digitorum tendons, L = lunate.

 

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