Anomalous Median Nerve Branching with Carpal Tunnel Syndrome

Knowledge of anatomy and its possible variations is vital for the successful management of peripheral nerve disorders. These anomalies can possibly lead to increased risk of compression and/or of inadvertent injury to the nerve. Lanz, in 1977,1 presented a landmark paper on various possible variations in median nerve anatomy at the carpal tunnel in 246 hands. He organized the variations in to four groups. Group III, representing the high or proximal bifurcation of the median nerve, was found in five hands. Similar reports of anomalieswere subsequentlymadeby Eiken et al,1 Kessler et al,1 andWilkenman et al.1 Effectively the incidence of Group III anomaly is estimated to be between 1 and 3.3%.2,3 The anomaly could be an isolated finding or be associated with a median artery1 and/or with an accessory muscle or a tendinous slip. Group III median nerve anomaly with an isolated compartment for the radial division of the nerve, within the carpal tunnel, was reported by Mitchell et al in 2009.2 The probability of inadvertently injuring the high branches of Group III median nerve was reported by Jeon et al, in year 2002.4 The palmar cutaneous branch is the only branch of the median nerve in the middle and distal forearm and the