Acute pain at the wrist 

You are seeing a 58-year-old patient who says that one week ago he suddenly experienced pain at the right wrist.

He has had a diagnosis of chronic polyarthritis for many years, which has already caused severe deformity of his hands. Therefore, he initially attributed the pain to this disorder.

In the following days, however, he noticed numbness of the fingertips of digits I to III, which is why he is referred to you. 

You scan the wrist and see this:

Obviously our patient has an anatomical variant –  a bifid median nerve, which comes with a persistent median artery. 

You take a close look and see this proximal:

You look distally and see this:

You turn on the color doppler:

There is some flow:

… that subsides distally:

What have we found here? 

A rare cause for carpal tunnel syndrome in its equally rare acute form:

Thrombosis of a persistent median artery. 

Have a look at the second pic again and see the hyperechogenic thrombus in the lumen of the artery. 

We hope this case was interesting for you. All the best!