The carpal tunnel syndrome is the most commonly reported nerve entrapment syndrome. While a number of medical risk factors are wellknown, accounting for approximately 25% af the cases, the significance of repetitive occupational hand strain has been disputed during several decades. Recently, a number of controlled epidemiological studies concerning this issue have emerged. A critical review arrives at the conclusion that jobs requiring highly repetitive and forceful sustained hand activity are associated with an increased risk for the carpal tunnel syndrome. The risk is, in particular, high when both risk factors are involved concomitantly. Exposure to hand-arm vibration also increases the risk, but it is undecided whether vibration per se or the associated ergonomic strain is the causal factor. It is argued that the evidence is sufficient to justify worker compensation and action should be taken to prevent this work-related disorder.