Background: Schwannomas are benign peripheral nerve sheath tumours arising from Schwann cells and are uncommon in the upper limb. Median nerve schwannomas constitute approximately 0.1–0.3% of all hand tumours, and extensive involvement of the median nerve by multiple schwannomas across multiple joints is exceptionally rare. Differentiating schwannoma from neurofibroma on imaging can be challenging.

Case Presentation: A patient presented with a painful palpable mass along the flexor aspect of the right forearm extending from the elbow to the distal interphalangeal joint. Clinical examination demonstrated a mobile mass with a positive Tinel’s sign along the median nerve distribution. Magnetic resonance imaging revealed a longitudinally extensive lesion along the median nerve but could not reliably differentiate schwannoma from neurofibroma. A core needle biopsy confirmed schwannoma with Antoni A and Antoni B areas and strong S-100 positivity. Complete surgical excision with preservation of the median nerve was performed, resulting in excellent functional recovery.

Conclusion: Extensive schwannomas involving the median nerve are rare and may present diagnostic challenges. Histopathological confirmation combined with meticulous nerve-preserving surgical excision allows accurate diagnosis and excellent functional outcomes.