BackgroundWe present a case of combined median nerve contusion with immediate loss of sensation after the strangulation with a wakeboarding rope and prolonged referral to our department 72 hours after the injury accompanied by an acute carpal tunnel syndrome with immediate relief of numbness of a significant proportion of the median nerve following surgical decompression.Case presentationThe palmar branch of the median nerve was surrounded by a significant haematoma in addition to the strangulation damage caused by its more superficial location in contrast to the median nerve.ConclusionIn case of acute median neuropathy, urgent surgical intervention with exploration, decompression of both, the median nerve and the superficial branch of the median nerve, accompanied by compartment measurements of the forearm should be performed to regain or re-establish neurological integrity.