Median nerve compression caused by superficial brachial artery: an unusual clinical case

Abstract

An iatrogenic pseudoaneurysm of the radial artery and spontaneous venous malformation are associated with median nerve compression. However, the superficial brachial artery (SBA) has rarely been described as the cause of neurological deficits due to median nerve compression. A 61-year-old man was admitted to our clinic with a 1-year history of intermittent aching palsy in the left thumb that had progressed to the first three fingers. Clinical examination revealed mild sensory disturbance and hyperpathia in the first three fingers and weakness of the opponens pollicis. Ultrasound and magnetic resonance imaging confirmed that the SBA was compressing the median nerve by almost one-third. When anomalies of the SBA impinge on the median nerve, pulsatile pressure is applied to the nerve trunk. This may trigger ectopic stimulation of sensory fibers, leading to severe pain, sensory neuropathy, and motor disturbance. Considering the substantial difficulties and risks of a surgical operation as well as the patient’s wish to undergo conservative treatment, we performed muscle relaxation and acupuncture to relieve the pressure of the surrounding soft tissue and in turn decrease the impingement of the SBA on the median nerve. A satisfactory treatment effect was reached in this case.