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Carpal tunnel syndrome is encountered frequently in the every day practice for many orthopaedic surgeons and neurosurgeons. However, the rate of recurrence or incomplete relief is high and difficult to treat. This may be related to the high percent of anomalies of the median nerve and its surrounding tissues. A case of a split median nerve entrapped by an abnormally inserted palmaris longus muscle is presented. The case is discussed and a conclusion of safer standard surgical release is recommended, especially in doubtful cases. © 1999 Wiley‐Liss, Inc. MICROSURGERY 19:404–405 1999