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Najd Mazhar F, Mohammadi R, Zareie B, mahmoudi nasab O, Jafari Kafiabadi M, Shariatzade H. Incidental Intraoperative Bifid Median Nerve in Two Cases of Carpal Tunnel Release. JROS 2025; 12 (2) :97-102
URL: http://jros.iums.ac.ir/article-1-2298-en.html

Background: The bifid median nerve (BMN) is a common anatomical variation that, when encountered unexpectedly during carpal tunnel release (CTR), can increase the risk of iatrogenic injury and complicate the surgical approach. This report discusses the intraoperative management and outcomes of two such cases.
Case Presentation: We present two cases of severe carpal tunnel syndrome in which a BMN (lanz type IIIA) was discovered incidentally during open CTR performed under wide awake local anesthesia no tourniquet (WALANT). In the first case, the discovery led to an extended proximal release to ensure complete decompression of the bifurcated nerve. In the second case, a conventional open approach was considered sufficient. Both patients experienced complete resolution of symptoms at the 12-month follow-up.
Conclusion: The incidental discovery of a BMN during CTR requires a thorough anatomical examination to ensure complete decompression and prevent iatrogenic injury. As demonstrated by our two cases, the surgical approach, whether extended or conventional, can be successfully adapted to the intraoperative findings. The crucial factor is visual confirmation that all nerve components are fully decompressed.