Bilateral Lipofibromatous Hamartoma of the Median Nerves Presenting as Longstanding Carpal Tunnel Syndrome

Case: A 44-year-old woman presented with longstanding bilateral median nerve symptoms refractory to conservative treatment. Nerve conduction studies demonstrated severe bilateral median neuropathy. MRI showed characteristic fibrofatty infiltration of the median nerves, establishing the diagnosis of lipofibromatous hamartoma without biopsy. Sequential extended open carpal tunnel decompression alone was performed on each side, resulting in complete symptom resolution at the 1-year follow-up. Conclusion: Lipofibromatous hamartoma should be considered in patients with atypical or early-onset carpal tunnel syndrome. This case highlights MRI as a noninvasive diagnostic tool and demonstrates that carpal tunnel decompression alone can achieve durable relief, avoiding biopsy, and nerve excision morbidity.