Carpal tunnel syndrome is rare in children. When it does occur in children, the most common causes reported are mucopolysaccharidosis and mucolipidosis. The median artery is a transitory vessel that develops from the axillary artery in early embryonic life and does not normally survive until postfetal life. In a small percentage of individuals, however, it persists into adulthood and is frequently accompanied by a bifid median nerve. A persistent median artery can be a cause of carpal tunnel syndrome in adults, but it is extremely rare in children and adolescents. This paper reports a case of a carpal tunnel syndrome caused by a persistent median artery and bifid median nerve in a 13-year-old girl.
Adolescent ; Adult ; Arteries ; Axillary Artery ; Carpal Tunnel Syndrome ; Child ; Female ; Humans ; Median Nerve ; Mucolipidoses ; Mucopolysaccharidoses

Axillary arch is relatively common variation of muscle in the axilla. There were several attentions on axillary arch due to its anatomical and surgical importance. During educational dissection, a variant muscle was found in right arm of 68-year-old female cadaver. The variation of muscle originated from the lateral edge of the latissimus dorsi muscle as muscular form. And then, it crossed the axillary artery and median nerve as tendinous form. Finally it became wide as muscular form and inserted into the pectoralis major. We reported this variant muscle and discussed its clinical significances.
Aged ; Arm ; Attention ; Axilla ; Axillary Artery ; Cadaver* ; Female ; Humans ; Median Nerve ; Superficial Back Muscles

Anatomic variations in the branching pattern of the axillary artery are common and have been studied by many authors. The origin of the anterior circumflex humeral artery is also various and its association with other variations has been focused recently. This study identified the origin of the anterior circumflex humeral artery, the communication between the musculocutaneous and median nerves, and the third head of the biceps brachii muscle, and then their associations were examined. Axillae of 75 cadavers were dissected and these variations were collected. The anterior circumflex humeral artery arose directly from the third parts of the axillary artery in 82.0% of upper limbs. It also arose as common stem for both humeral arteries in 7.3% of the third part of the axillary artery and in 5.3% of the subscapular artery, respectively. The anterior circumflex humeral artery was absent in 2.7% and two anterior circumflex humeral artery was found in 1.3% of limbs. The communication between the musculocutaneous and median nerves and the third head of the biceps brachii muscle were found in 32.0% and 16.0% of upper limbs, respectively. These variations were not statistically associated with each other. These results may provide deep knowledge about the anatomy of the anterior circumflex humeral artery and contribute to explain its clinical implications.
Arteries* ; Axilla ; Axillary Artery ; Cadaver ; Extremities ; Head ; Median Nerve ; Upper Extremity

A 73-year-old woman who underwent combined bioprosthetic mitral valve replacement, tricuspid ring annuloplasty, and coronary artery bypass grafting 12 years previously visited our clinic due to aggravated dyspnea caused by structural valve deterioration of the mitral prosthesis. Because aortic or femoral artery cannulation and cross-clamping would have a high risk of stroke owing to severe calcification of the ascending aorta and ilio-femoral vessels, and because there was a risk of redo sternotomy due to the patent bypass grafts, a comprehensive approach including axillary artery cannulation, a minimally invasive right thoracotomy approach, and a clampless hypothermic fibrillatory arrest technique was used during redo mitral valve replacement.
Aged ; Aorta* ; Axillary Artery ; Catheterization ; Coronary Artery Bypass ; Dyspnea ; Female ; Femoral Artery ; Humans ; Minimally Invasive Surgical Procedures ; Mitral Valve* ; Prostheses and Implants ; Reoperation ; Sternotomy ; Stroke ; Thoracotomy ; Transplants*

The axillary artery (AA) is often referred to as having three parts, with these divisions based on its location relative to the pectoralis minor muscle. In third part, AA gives off the subscapular (SSA), anterior circumflex humeral, and posterior circumflex humeral arteries (PCHA). However, variations in these arteries were extremely diverse. So, we observed actually some branching patterns of these arteries in this study. METHOD: We studied the pattern of SSA in 128 upper limbs from donated cadavers. RESULT: SSA was originated directly from the third and second parts of AA in 37.5% (48/128) and 4.7% (6/128), respectively. A PCHA made a common trunk with SSA in 25.8% (33/128), and these trunks arose from the third and second parts of AA in 21.1% (27/128) and 4.7% (6/128), respectively. A lateral thoracic artery (LTA) arose from SSA in 12.5% (16/128), and these were originated from the third and second parts of AA in 4.7% (6/128) and 7.8% (10/128), respectively. In 19.5% (25/128) of upper limbs, LTA, SSA, and PCHA have a common trunk, and these arose from the third and second parts of AA in 12.5% (16/128) and 7.0% (9/128), respectively. According to the branching pattern of the SSA, its origin was significantly different.
Arteries* ; Axillary Artery* ; Cadaver ; Methods ; Thoracic Arteries ; Upper Extremity

BACKGROUND: The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4'). METHODS: Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves. RESULTS: Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033). CONCLUSIONS: A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.
Axillary Artery* ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Needles* ; Radial Nerve ; Scalp ; Ulnar Nerve ; Veins

BACKGROUND: The authors sought to determine whether a shallow needle approach to the axillary artery would improve complete sensory blocks of median, radial, and ulnar nerves as compared with a perpendicular approach when transarterial axillary block is performed using a scalp vein needle (23G, 3/4'). METHODS: Fifty-four patients were allocated equally to a perpendicular group (the PA group) or a shallow approach group (SA group). Sensory and motor scores were evaluated and compared in the two groups at 5-minute intervals for 20 minutes after block. The main outcome variables were rates of blockage of median, radial, and ulnar nerves. RESULTS: Excellent block rates (defined as completion of surgery using brachial plexus block alone) were obtained in both groups (SA group 77.8% vs. PA group 70.3%, P = 0.755). However, the rate of blockage of all three nerves was significantly higher in the SA group (74% vs. 40.7%, P = 0.013). Furthermore, the rate of complete sensory block of the radial nerve at 20 minutes was significantly greater in the SA group (85.2% vs. 59.3%, P = 0.033). CONCLUSIONS: A shallow needle approach to the axillary artery resulted in a significantly higher median, radial, and ulnar nerve block rate at 20 minutes after LA injection than a perpendicular approach.
Axillary Artery* ; Brachial Plexus Block* ; Brachial Plexus* ; Humans ; Needles* ; Radial Nerve ; Scalp ; Ulnar Nerve ; Veins

Stent migration and loss are rare but can be devastating complications during percutaneous coronary intervention (PCI) for coronary artery disease. We report a unique case of wandering stent from the right coronary artery to the femoral artery via the axillary artery. Initially, the stent was stripped from the delivery catheter and embolized to axillary artery during emergent PCI. An intra-aortic balloon pump might have forced retrograde movement of the stent to axillary artery which have subsequently remobilized to the femoral artery. After stabilization, the stent was successfully removed by a percutaneous approach using a snare. Immediate retrieval of wandering stent is recommended for the prevention of secondary embolization.
Axillary Artery* ; Catheters ; Coronary Artery Disease ; Coronary Vessels ; Drug-Eluting Stents ; Embolism ; Femoral Artery* ; Percutaneous Coronary Intervention ; SNARE Proteins ; Stents*

During gross anatomy dissection, variation in the formation of median nerve of the upper limb was discovered in the right upper extremity of a 57-year-old male cadaver. Three roots contributed to the formation of median nerve instead of usual two roots i.e. two lateral roots and one medial root. After being formed the median nerve descended medial to the axillary artery. Between the two lateral roots brachial vein passed to open into the axillary vein. Anatomical variations in the formation of nerves and their unusual relationship to the surrounding structures can be the cause of nerve compression syndromes and vascular problems.
Axillary Artery ; Axillary Vein

Variations of the vascular pattern of proximal part of the upper arm are very common. Knowledge of anomalies in the origin and course of principal arteries is important for the vascular radiologists and surgeons. Several variations of the axillary artery, brachial artery and theirs branches have been reported. We found a common trunk (about 3cm long) of lateral thoracic and subscapular arteries from the axillary artery and a common trunk (about 4cm long) of posterior circumflex humeral and profunda brachii arteries from brachial artery. The profunda brachii artery ran downwards along with radial nerve and entered the radial groove. The posterior circumflex humeral artery hooked around the aponeurosis of latissimus dorsi muscle and supplied its usual area around the glenohumeral joint.
Axillary Artery ; Branchial Artery