Fibrolipomatous hamartoma: 51-year-old female with prior middle finger resection for congenital macrodactyly, presented with three months of numbness and tingling in the fingers. On physical examination (a), a protruding mass was seen along the course of the median nerve at the carpal tunnel. Corresponding frontal radiograph (b) of the left hand demonstrates postoperative changes from resection of the middle finger with heterotopic bone formation in the surgical bed. Advanced degenerative changes are seen, predominately at the thumb carpometacarpal and distal interphalangeal joints. Coronal (c, d) and sagittal T1W (e) images of the left wrist demonstrate the serpentine appearance of the median nerve fascicles with surrounding fat proliferation. Axial T2W non-fat-saturated images of the left wrist reveal fibrofatty infiltration of the median nerve (f, g). These images demonstrate the “co-axial cable” appearance of the nerve fascicles. The digital nerve branches are also involved (h). Pre- (i) and post-contrast (j) axial T1W images of the left wrist show avid enhancement of the median nerve fascicles following the administration of intravenous gadolinium. Intraoperative image (k) shows a fibrofatty mass of the median nerve at the distal left wrist, corresponding with mass seen on physical examination.