Plain radiographs are not diagnostic for CTS, as they cannot visualize the median nerve or soft tissues. They may, however, be useful in identifying secondary causes or mimics, such as:

• Bony abnormalities: distal radius or carpal fractures, malunions, deformities.

• Arthritic changes: osteoarthritis, rheumatoid arthritis, degenerative changes.

• Space-occupying lesions: calcifications, osteophytes, bone cysts.

• Metabolic disorders: gout, acromegaly.

Radiographs not necessary for diagnosis

Plain radiographs are not diagnostic for carpal tunnel syndrome, as they cannot visualize the median nerve or soft tissue compression within the carpal tunnel.

• X-rays may be obtained in selected cases to evaluate secondary causes or associated conditions that predispose to or mimic CTS.

These include:

• Bony abnormalities: Distal radius or carpal fractures, malunions, or deformities that reduce carpal tunnel volume.

• Arthritic changes: Osteoarthritis, rheumatoid arthritis, or degenerative changes of the wrist and carpal bones that may contribute to narrowing of the tunnel.

• Space-occupying lesions: Calcifications, osteophytes, or bone cysts that may impinge on the median nerve.

• Metabolic or systemic disorders: Evidence of conditions such as gout (urate deposits) or acromegaly (enlarged carpal bones).

Because of its limited utility in direct nerve assessment, radiography is generally used as an adjunct, primarily to rule out structural causes rather than to confirm CTS itself