Usually presents with intermittent tingling of one or both hands that can extend proximally to the elbow or even the arm. The symptoms are often provoked or aggravated by certain activities such as knitting, driving, mouse manipulation, repetitive manual work and often awaken people at night or are present upon awakening in the morning. In more severe cases the tingling can be constant and at times accompanied by shooting pain in the fingers and dropping of objects. The symptoms are caused by the compression of the median nerve at the wrist. Some medical conditions such as inflammatory arthritis, hypothyroidism can predispose to having a carpal tunnel syndrome. A physician referral is required.