Most cases of CTS are idiopathic (without known cause); genetic factors determine most of the risk, and the role of arm use and other environmental factors is disputed.

Night symptoms and waking at night—the hallmark of this illness—can be managed effectively with night-time wrist splinting in most patients. The role of medications, including corticosteroid injection into the carpal canal, is unclear. Surgery to cut the transverse carpal ligament is effective at relieving symptoms and preventing ongoing nerve damage, but established nerve dysfunction in the form of static (constant) numbness, atrophy, or weakness are usually permanent and do not respond predictably to surgery.