The clinical and electrophysiologic characteristics of carpal tunnel syndrome (CTS) in elderly adults are not well established. We examined age differences in clinical, functional, and electrophysiologic features in elderly adults referred to a neuromuscular service for evaluation of symptoms suggestive of CTS. Of 415 consecutive subjects referred over an 18-month period, 343 met clinical criteria for CTS. There were 158 young (<or=50 years), 115 middle-aged (51-64 years), and 70 elderly adults (>or=65 years). There were no age differences in the duration of CTS symptoms, hand function, or presence of autonomic symptoms. The elderly adults had a higher prevalence of thenar weakness and thenar atrophy than younger subjects. Electrophysiologic abnormalities were more common and more severe in the older subjects. Our study shows that although there are no age differences in subjective complaints of CTS, older adults had objective clinical and electrophysiologic evidence of a more severe median nerve entrapment. The findings suggest that greater attention needs to be paid to objective evidence of CTS severity rather than subjective complaints when evaluating elderly adults presenting for clinical evaluation of CTS.