 Background a rare case of carpal tunnel syndrome caused by a thrombose persistent median artery is presented here. Case the diagnosis was delayed due to the overlapping cervical radiculopathy. Acute severe pain and nocturnal peristhesia were chief complaints. Ultrasonography, magnetic resonance imaging and computed tomography and geography revealed that the median nerve was compressed by the occluded median artery. Instead of surgery, conservative therapy was tried. It worked well for six months. Conclusions the importance of using modalities for decision making of diagnosis and treatment is emphasized in this report. This article was authored by Sanyin John, Quang Lin Lee, and we on Jun Yong