{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T21:58:55Z","timestamp":1790027935500,"version":"4.0.1"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T00:00:00Z","timestamp":1675900800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000001","name":"National Science Foundation","doi-asserted-by":"publisher","award":["2015GXNSFCA1598011-5"],"award-info":[{"award-number":["2015GXNSFCA1598011-5"]}],"id":[{"id":"10.13039\/100000001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Carpal tunnel syndrome (CTS) is an upper extremity median nerve entrapment disorder that is rare in children and adolescents. Anatomical variations of the wrist, such as anomalous muscles, persistent median artery (PMA), and bifid median nerves (BMN), are rare etiology of CTS. Coexistence of all three variants combined with CTS in adolescents has been rarely reported. Case description: A 16-year-old right-hand dominant male presented to our clinic with several years of bilateral thenar muscle atrophy and weakness but no paresthesia or pain in his both hands. Ultrasonography showed that the right median nerve become significantly thinner, and the left median nerve was split into two branches by PMA. Magnetic resonance imaging (MRI) revealed that anomalous muscles in the bilateral wrist extending to the carpal tunnel, causing compression of the median nerve. Considering the possibility of CTS clinically, the patient underwent bilateral open carpal tunnel release without resection of anomalous muscles and PMA. The patient has no discomfort after 2 years. This suggests that anatomical variations of the carpal tunnel may contribute to CTS, which can be confirmed by preoperative ultrasonography and MRI, and the possibility of carpal tunnel anatomical variations should be considered when CTS occurs in adolescents. Open carpal tunnel release is an effective treatment for juvenile CTS without the need to resect abnormal muscle and PMA during the operation.<\/jats:p>","DOI":"10.3389\/fped.2023.1043442","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T08:46:52Z","timestamp":1675932412000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Coexistence of anomalous muscle, persistent median artery, bifid median nerve causing carpal tunnel syndrome: A case report and literature review"],"prefix":"10.3389","volume":"11","author":[{"given":"Jun","family":"Qin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xia-xian","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming-qiang","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing-wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-min","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ke","family":"Sha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,2,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"624","DOI":"10.3390\/children8080624","article-title":"Etiology of carpal tunnel syndrome in a large cohort of children","volume":"8","author":"R\u00fcsch","year":"2021","journal-title":"Children (Basel)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1016\/j.jhsa.2020.09.009","article-title":"Outcomes of pediatric and adolescent carpal tunnel release","volume":"46","author":"Velicki","year":"2021","journal-title":"J Hand Surg Am"},{"key":"B3","doi-asserted-by":"publisher","first-page":"849","DOI":"10.1016\/s0363-5023(03)00365-4","article-title":"Prevalence of anatomic variations encountered in elective carpal tunnel release","volume":"28","author":"Lindley","year":"2003","journal-title":"J Hand Surg Am"},{"key":"B4","doi-asserted-by":"publisher","first-page":"285","DOI":"10.0161904\/AIM.0011","article-title":"Anatomic anomalies encountered in 467 open carpal tunnel surgeries","volume":"19","author":"Afshar","year":"2016","journal-title":"Arch Iran Med"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1273","DOI":"10.1016\/s1474-4422(16)30231-9","article-title":"Carpal tunnel syndrome: clinical features Diagnosis, and Management","volume":"15","author":"Padua","year":"2016","journal-title":"Lancet Neurol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e1900468","DOI":"10.2106\/JBJS.CC.19.00468","article-title":"Unusual triad of bifid median nerve, persistent median artery, and aberrant muscle causing carpal tunnel syndrome: a case report","volume":"10","author":"Dhal","year":"2020","journal-title":"JBJS Case Connect"},{"key":"B7","doi-asserted-by":"publisher","first-page":"862","DOI":"10.3928\/0147-7447-20040801-23","article-title":"Carpal tunnel syndrome due to tophaceous gout","volume":"27","author":"Rich","year":"2004","journal-title":"Orthopedics"},{"key":"B8","doi-asserted-by":"publisher","first-page":"14","DOI":"10.1177\/1753193411414352","article-title":"Unusual causes of carpal tunnel syndrome: space occupying lesions","volume":"37","author":"Chen","year":"2012","journal-title":"J Hand Surg Eur"},{"key":"B9","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1016\/0899-7071(94)00036-C","article-title":"Mr demonstration of an anomalous muscle in a patient with coexistent carpal and ulnar tunnel syndrome. Case report and literature summary","volume":"19","author":"Zeiss","year":"1995","journal-title":"Clin Imaging"},{"key":"B10","doi-asserted-by":"publisher","first-page":"358","DOI":"10.6061\/clinics\/2017(06)05","article-title":"Sonographic findings of the bifid median nerve and persistent median artery in carpal tunnel: a preliminary study in Chinese individuals","volume":"72","author":"Chen","year":"2017","journal-title":"Clinics"},{"key":"B11","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1002\/mus.27148","article-title":"Neuromuscular ultrasound findings in carpal tunnel syndrome with symptoms mainly in the nondominant hand","volume":"63","author":"Chompoopong","year":"2021","journal-title":"Muscle Nerve"},{"key":"B12","first-page":"431","article-title":"Median and ulnar nerve compression at the wrist caused by anomalous muscles","volume":"68","author":"De Smet","year":"2002","journal-title":"Acta Orthop Belg"},{"key":"B13","doi-asserted-by":"publisher","first-page":"218","DOI":"10.1016\/s0363-5023(86)80054-5","article-title":"Carpal tunnel syndrome caused by aberrant lumbrical muscles associated with cystic degeneration of the tenosynovium: a case report","volume":"11","author":"Asai","year":"1986","journal-title":"J Hand Surg Am"},{"key":"B14","doi-asserted-by":"publisher","first-page":"149","DOI":"10.3109\/02844318909004509","article-title":"The treatment of carpal tunnel syndrome caused by hypertrophied lumbrical muscles. Case reports","volume":"23","author":"Robinson","year":"1989","journal-title":"Scand J Plast Reconstr Surg Hand Surg"},{"key":"B15","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1007\/s11552-014-9622-1","article-title":"Carpal tunnel syndrome secondary to an accessory flexor digitorum Superficialis muscle belly: case report and review of the literature","volume":"9","author":"Javed","year":"2014","journal-title":"Hand (N Y)"},{"key":"B16","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1016\/j.jhsb.2006.07.015","article-title":"The clinical significance of the Palmaris Longus tendon in the pathophysiology of carpal tunnel syndrome","volume":"31","author":"Keese","year":"2006","journal-title":"J Hand Surg Br"},{"key":"B17","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/0363-5023(90)90125-B","article-title":"Bilateral Palmaris Profundus causing bilateral carpal tunnel syndrome","volume":"15","author":"Floyd","year":"1990","journal-title":"J Hand Surg Am"},{"key":"B18","doi-asserted-by":"publisher","first-page":"357","DOI":"10.3928\/0147-7447-19790701-04","article-title":"Aberrant lumbrical muscles causing carpal tunnel syndrome","volume":"2","author":"Wiss","year":"1979","journal-title":"Orthopedics"},{"key":"B19","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/S0072-968X(81)80038-1","article-title":"Carpal tunnel syndrome produced by an organising haematoma within the anomalous second lumbrical muscle","volume":"13","author":"Nather","year":"1981","journal-title":"Hand"},{"key":"B20","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1002\/mus.24183","article-title":"Muscle intrusion as a potential cause of carpal tunnel syndrome","volume":"50","author":"Cartwright","year":"2014","journal-title":"Muscle Nerve"},{"key":"B21","doi-asserted-by":"publisher","first-page":"1744","DOI":"10.2106\/00004623-197355080-00019","article-title":"Anomalous median nerve and an anomalous muscle belly of the first lumbrical associated with carpal-tunnel syndrome","volume":"55","author":"Schultz","year":"1973","journal-title":"J Bone Jt Surg Am Vol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1016\/0266-7681(94)90206-2","article-title":"Lumbrical muscle incursion into the carpal tunnel during finger flexion","volume":"19","author":"Cobb","year":"1994","journal-title":"J Hand Surg (Edinburgh, Scotland)"},{"key":"B23","doi-asserted-by":"publisher","first-page":"860","DOI":"10.1016\/S0363-5023(05)80444-7","article-title":"Anatomic investigation of the role of the lumbrical muscles in carpal tunnel syndrome","volume":"20","author":"Siegel","year":"1995","journal-title":"J Hand Surg Am"},{"key":"B24","doi-asserted-by":"publisher","first-page":"616","DOI":"10.1016\/0266-7681(94)90128-7","article-title":"Bifid median nerve compression due to a musculotendinous anomaly of fds to the middle finger","volume":"19","author":"Fernandez-Garcia","year":"1994","journal-title":"J Hand Surg (Edinburgh, Scotland)"},{"key":"B25","doi-asserted-by":"publisher","first-page":"615","DOI":"10.1007\/s10072-011-0582-8","article-title":"Prevalence of bifid median nerve at wrist assessed through ultrasound","volume":"32","author":"Granata","year":"2011","journal-title":"Neurol Sci"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.2147\/JPR.S303142","article-title":"Electrodiagnostic, sonographic, and clinical features of carpal tunnel syndrome with bifid median nerve","volume":"14","author":"Park","year":"2021","journal-title":"J Pain Res"},{"key":"B27","doi-asserted-by":"publisher","first-page":"13","DOI":"10.3109\/02844319709010500","article-title":"Median artery and superficial palmar branch of the radial artery in the carpal tunnel","volume":"31","author":"Olave","year":"1997","journal-title":"Scand J Plast Reconstr Surg Hand Surg"},{"key":"B28","doi-asserted-by":"publisher","first-page":"154","DOI":"10.1007\/s00402-004-0637-x","article-title":"Can simple release relieve symptoms of carpal tunnel syndrome caused by a persistent median artery? Clinical experience","volume":"124","author":"Bilgin","year":"2004","journal-title":"Arch Orthop Trauma Surg"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1002\/ca.23770","article-title":"The persistent median artery and its vascular patterns: a meta-analysis of 10,394 subjects","volume":"34","author":"Solewski","year":"2021","journal-title":"Clin Anat"},{"key":"B30","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1007\/s00276-015-1544-2","article-title":"Prevalence of persistent median artery in carpal tunnel syndrome: sonographic assessment","volume":"38","author":"Altinkaya","year":"2016","journal-title":"Surg Radiol Anat"},{"key":"B31","doi-asserted-by":"publisher","first-page":"e2000139","DOI":"10.2106\/JBJS.CC.20.00139","article-title":"Surgical excision of a thrombosed persistent median artery causing carpal tunnel-like symptoms: a case report","volume":"10","author":"Bartels","year":"2020","journal-title":"JBJS Case Connect"},{"key":"B32","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1016\/j.jhsa.2015.01.026","article-title":"Idiopathic carpal tunnel syndrome in children and adolescents","volume":"40","author":"Batdorf","year":"2015","journal-title":"J Hand Surg Am"},{"key":"B33","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1002\/mus.880020604","article-title":"Thenar hypoplasia with associated radiologic abnormalities","volume":"2","author":"Cavanagh","year":"1979","journal-title":"Muscle Nerve"},{"key":"B34","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1177\/088307380201700114","article-title":"Cavanagh's syndrome (congenital thenar hypoplasia)","volume":"17","author":"Sonel","year":"2002","journal-title":"J Child Neurol"},{"key":"B35","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.cnp.2021.09.003","article-title":"Ultrasonography in patients with congenital thenar hypoplasia (cavanagh syndrome) and co-morbid carpal tunnel syndrome","volume":"6","author":"Iyer","year":"2021","journal-title":"Clin Neurophysiol Pract"},{"key":"B36","doi-asserted-by":"publisher","first-page":"811943","DOI":"10.3389\/fneur.2021.811943","article-title":"Update on the pathogenesis, clinical diagnosis, and treatment of hirayama disease","volume":"12","author":"Wang","year":"2021","journal-title":"Front Neurol"},{"key":"B37","doi-asserted-by":"publisher","first-page":"10.2106","DOI":"10.2106\/JBJS.CC.21.00311","article-title":"Anomalous flexor digitorum Profundus muscle bellies as a cause of snapping wrist and carpal tunnel syndrome: a case report","volume":"11","author":"Falcon","year":"2021","journal-title":"JBJS Case Connect"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1043442\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T08:46:57Z","timestamp":1675932417000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2023.1043442\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,9]]},"references-count":37,"alternative-id":["10.3389\/fped.2023.1043442"],"URL":"https:\/\/doi.org\/10.3389\/fped.2023.1043442","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,9]]},"article-number":"1043442"}}