Carpal tunnel syndrome has a lifetime prevalence of 3.1% and an incidence of 1.73 per 1,000 person-years, making it the most common upper-extremity compressive neuropathy. Damage to the nerve when chronically compressed is due to the resultant nerve ischemia and to endoneurial and extraneural edema, which interfere with axonal transport. Surgical treatment for carpal tunnel syndrome involves release of the transverse carpal ligament to release pressure on the median nerve. Recalcitrant carpal tunnel syndrome or recurrent symptoms after initial carpal tunnel release may be due to a variety of etiologies. Persistent symptoms may be due to variant anatomy, incomplete decompression of the nerve, additional sites of compression of the nerve, adhesions around the nerve, chronic compression leading to irreversible damage to the nerve, or incorrect preoperative diagnosis.