The objective of this study was to evaluate the use of routine wrist radiography in the evaluation of patients with carpal tunnel syndrome (CTS). In the setting of a community-based hand surgery practice, we performed a retrospective review of charts and radiographs for 300 consecutive patients (447 wrists) meeting clinical and electrophysiologic criteria for CTS. Data on all patients included information obtained by the use of medical history questionnaires, physical examinations, nerve conduction studies, and radiographs of the wrist. Abnormalities were noted in 146 of 447 wrist radiographs (33%). Eighty-three (18.6%) had abnormalities that might have been implicated in the development of CTS, although these findings would not alter management. For only 2 of 447 wrists (0.4% of wrists; 0.6% of patients) were there radiographic findings of therapeutic significance. Radiographic charges were calculated to be $5,869 to $20,115 for each finding of therapeutic significance. We conclude that wrist radiographs should not be performed routinely in patients with CTS, owing to the low yield of useful information.