The correspondence article discusses the DISTRICTS study evaluating the treatment of carpal tunnel syndrome. The study compares two strategies: initial treatment with surgery and initial treatment with corticosteroid injection. It is a multicenter, open, randomized controlled trial in patients with carpal tunnel syndrome. The primary objective is to determine whether initial surgical treatment leads to a better clinical outcome and is more cost-effective compared with corticosteroid injection. The main indicator is the proportion of patients who are "recovered" after 18 months, i.e. they have no or only mild symptoms as measured by the 6-item carpal tunnel syndrome symptom scale. Adult patients with carpal tunnel syndrome are included in the study, while further follow-up treatment after the first procedure is not strictly determined by the protocol. The study was approved by the ethics committee and registered in the international registry of clinical trials.