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Work-related carpal tunnel syndrome (CTS) is a complex and costly condition. There is some evidence that the employment outcome may be worse in cases of CTS where the condition is being considered for compensation.To examine whether workers’ compensation status is an important determinant of outcome of CTS.Cases, with a Workers’ Compensation Board (WCB) claim, and referents, in work but without a WCB claim, were identified from the practice of a single specialist physician. Data on history prior to and at the time of diagnosis, and events since diagnosis, were collected from clinical records and by a telephone-administered questionnaire. Prior events, severity, treatment and outcome associated with a WCB claim were assessed by logistic regression.Interviews were successfully completed for 46 cases and 50 referents. In the model adjusted only for age and gender, claimants had a worse outcome in terms of changing job or stopping work with time loss from work due to CTS [odds ratio (OR) 5.1, 95% confidence interval (CI) 1.9–13.3]. The OR was much influenced by the inclusion of treatment in the model (OR=9.6, 95% CI 1.6–58.6) with WCB cases more likely to have surgical and physiotherapy treatments. Cases with a WCB claim cost more to treat and reported greater loss in income than those not seeking compensation.Although these data are limited, the results are suggestive of poorer outcome among WCB claimants despite greater use of treatment and comparable severity of disease.