Carpal tunnel syndrome (CTS) is the most common peripheral nerve entrapment neuropathy, with extensive literature dedicated to its diagnosis and management. However, symptoms in the median nerve distribution may also arise from pathologies of the median nerve or its branches at sites beyond the carpal tunnel.

Proximal median nerve compressions can occur independently or in conjunction with carpal tunnel syndrome and are often underrecognized due to their infrequent presentation, overlapping clinical features, and limited description in the literature. Recent studies suggest that unrecognised median nerve entrapments at these sites constitute an important cause of recurrence or failure after carpal tunnel interventions [1].

Electroneuromyographic (ENMG) studies can be inconclusive in determining the level of median nerve pathology, especially in early cases, underscoring the importance of imaging assessment [1,2]. Ultrasound(US), by virtue of its high-resolution imaging with high-frequency linear-array transducers, real-time and dynamic stress assessment, and easy accessibility, forms the cornerstone of peripheral nerve imaging [3,4].

The exhibit illustrates cases of median nerve compression at the elbow and forearm by the lacertus fibrosus, between the two heads of pronator teres, beneath the flexor digitorum superficialis arch, double-crush syndrome, and post-operative entrapments. Additional cases include pathologies involving its branches, such as the anterior interosseous nerve, palmar cutaneous branch, and recurrent motor branch, which have also been discussed.