Carpal tunnel syndrome (CTS) is the most frequently encountered entrapment of the peripheral nerves in the upper extremity. Abnormal anatomical variations involving the recurrent motor branch of the median nerve and presence of a palmaris profundus tendon have been reported. We present a 53-year-old man in whom open carpal tunnel release led to complete resolution of numbness, tingling, and pain in the right hand by 1 month postoperatively. Intraoperatively, the simultaneous presence of a transligamentous recurrent motor branch of the median nerve and palmaris profundus tendon in the carpal tunnel was found and excised. Surgeons should be aware of the potential presence of these abnormalities in successfully treating patients with CTS.

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