Acute carpal tunnel syndrome is characterized by rapid onset of median neuropathy caused by sudden increases in carpal tunnel pressures, which leads to ischemia of the median nerve. The most common cause is traumatic injury, although atraumatic sources should also be recognized. Patients generally complain of pain, lose two-point discrimination, and may demonstrate elevated compartment pressure on measurement. Prompt recognition and surgical decompression are imperative to spare median nerve viability.