Abstract: Carpal tunnel syndrome (CTS) can be an initial sign of underlying undiagnosed disorders like hypothyroidism or rheumatoid arthritis. The erosive type of CTS is rare and generally requires carpal tunnel release surgery as a treatment modality. A 55-year-old gentleman presented with paraesthesia and spontaneous digital ulceration of the distal finger in both hands over 5 months. Initially managed as some vascular disorder by physicians, later on, in nerve conduction studies, CTS was diagnosed. The patient was further investigated for etiology leading to the diagnosis of hypothyroidism and rheumatoid arthritis. These were managed with medications, and CTS was managed with the surgical release. The paraesthesia was relieved post-surgically, and the digital ulceration healed over a few weeks. Digital ulcerations can be a presentation of CTS rather than vascular/vessel disorder. The physician should be aware of CTS erosive variety and further investigate the etiology like hypothyroidism and rheumatoid arthritis. The etiological factors should be treated first before embarking on surgical carpal tunnel release.