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An anomalous course of

An anomalous course of
the radial artery: Dissect
rather than resect
Sir,
Carpal tunnel syndrome is the most common entrapment
neuropathy. Rare aberrant-bifid tendon, muscle, nerve or
arterial anomalies may be the cause of this syndrome.[1]
Experienced surgeons do not fail to examine the tunnel
for anomalies during the operation. We however came
across an extra-tunnel arterial anomaly during one such
carpal tunnel decompression.

During surgery for scaphoid non-union, Afshar[2] noted an
anomalous radial artery that crossed the tendon of the
flexor carpi radialis muscle and travelled superficial to
the thenar muscles. The anomaly in the present case was
similar to this one but it was more on the medial aspect.
Some surgeons prefer local anaesthesia during carpal
tunnel decompression.[4] However, in the presence of the
anomaly we encountered, infiltration of local anaesthetic
agent at the operating site may result in arterial damage.
In conclusion, awareness on the possibility of
encountering known intra-tunnel anomalies as well as
extra-tunnel anomalies and avoiding local anaesthesia,
under the light of these findings, during decompression
surgery is important.