Abstract Carpal tunnel syndrome (CTS) stands as the most common entrapment neuropathy. The PMA, a transient embryonic vessel, is found in approximately 3-7% of the population, yet it is extremely rare to present as a possible symptomatic space-occupying lesion or a source of pulsatile compression within the carpal tunnel. Herein, we report a case of a 66-year-old female with CTS together with large PMA, surgically treated by simple open carpal tunnel release. Following meticulous surgical decompression and preservation of the artery in situ, the patient achieved complete symptomatic relief. Post-operative high-resolution sonography was utilized to confirm the vascular anomaly and document the successful decompression. This case underscores a critical diagnostic dilemma in orthopedic surgery: performing a blind carpal tunnel release in the elderly without prior imaging carries an inherent danger, as failure to detect such a variant preoperatively risks iatrogenic vascular injury.
Al-Sadek et al. (2026) studied this question.