Abstract Details

Title Persistent Median Artery Thrombosis: A Rare Cause of Carpal Tunnel Syndrome

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) Neuromuscular and Clinical Neurophysiology (EMG) Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 143

Objective NA

Background The most common compressive neuropathy is carpal tunnel syndrome. It is important to identify rare underlying causes of carpal tunnel syndrome that may require disease-specific treatment.

Design/Methods We report the case of a 31 year old man who presented with one week history of progressively worsening left wrist pain and sensory abnormalities in the hand without color or temperature change. There was no preceding trauma and he was a lifelong non-smoker. He had decreased sensation to light touch and pinprick involving the left 1^st-3^rd digits, positive Phalen maneuver, and positive Tinel sign on physical exam. He had normal nerve conduction studies and EMG two weeks after onset, but a 10 cm thrombosis of an anomalous median artery traversing the carpal tunnel was discovered on left wrist ultrasound as the cause of the carpal tunnel syndrome. He had elevated rheumatoid factor, ANA, and SS-A antibodies of unclear significance and thrombophilia panel and urine toxicology screen were negative. Transthoracic echocardiogram revealed a moderately-sized patent foramen ovale with right to left shunt, but ultrasound of the lower extremities was unrevealing and the thrombosis was most likely cryptogenic. Treatment with therapeutic anticoagulation and combined carpal tunnel release and persistent median artery resection was completed. Symptoms resolved within 14 days of surgery.

Results NA

Conclusions Persistent median artery thrombosis resulting in median nerve compression at the wrist is a rare cause of carpal tunnel syndrome that can be identified by ultrasound or MRI and its detection has important implications for treatment.

Authors/Disclosures
Ashley Santilli, MD (Mayo Clinic) PRESENTER	Dr. Santilli has nothing to disclose.
	No disclosure on file
	No disclosure on file
Eoin P. Flanagan, MBBCh, F�鶹��ýӳ�� (Mayo Clinic)	The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to �鶹��ýӳ�� interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to �鶹��ýӳ�� interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to �鶹��ýӳ�� interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to �鶹��ýӳ�� interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to �鶹��ýӳ�� interests or activities.

�鶹��ýӳ��

�鶹��ýӳ��