Compression of the median nerve at the wrist (carpal tunnel syndrome) is the most common compression neuropathy of the upper extremity. Surgical decompression has become one of the most frequently performed peripheral nerve procedures. Despite the popularity of the procedure, and the volume of clinical and basic science information available, differences of opinion exist as to diagnosis and management. This review discusses several of these controversies and presents both recent and historical data that have led to some of these disagreements.