Carpal tunnel syndrome, bilateral, albeit more severe on the right side, was diagnosed by neurophysiological examinations in a 52-year-old female patient who presented with nocturnal pain, tingling and numbness for the past 2 years. During the carpal release operation performed under axillary anaesthesia with the pneumatic tourniquet, we observed that the radial artery ran superficial to the transverse carpal ligament and turned medially distal to the ligament [Figure 1]. The distal course of the artery could not be visualised due to the limitation of the incision. Intra-tunnel structures appeared normal when the transverse carpal ligament was incised. The advanced dissection could not be done due to the mediolegal problems. After release of the pneumatic tourniquet, the abnormal vascular anatomy was confirmed with examination of the arterial pulse. The arterial pulse was dislocated medially over the snuff box. On the contralateral side, the arterial pulsation was established at the normal anatomical location. The patient refused further investigation such as angiography for complete anatomical course of the artery.