Background: Carpal tunnel syndrome (CTS) is the most prevalent peripheral entrapment neuropathy, affecting 3.8% of the population, particularly middle-aged women. It results from compression of the median nerve in the carpal tunnel due to mechanical, vascular, or ischemic factors. Traditional diagnosis relies on clinical evaluation and electrodiagnostic studies, but these can be invasive and uncomfortable. Recent advancements in ultrasound (US) technology provide a non-invasive, dynamic, and cost-effective imaging modality for CTS evaluation, enabling structural and functional assessment of the median nerve and surrounding tissues. Objective: This review aimed to provide an in-depth analysis of the role of ultrasound in the diagnosis of CTS, highlighting anatomical, epidemiological, and pathophysiological features. It further explored static, dynamic, and elastographic ultrasound techniques, comparing their diagnostic performance and clinical utility with conventional methods. Methods: A thorough literature review was performed utilizing PubMed, Scopus, and Web of Science databases, employing the search terms: Carpal tunnel syndrome, ultrasound, median nerve, elastography, speckle tracking, and nerve entrapment. The selection criteria included studies published in English between 2000 and 2024 that presented original research or comprehensive reviews related to the use of ultrasound in the evaluation of carpal tunnel syndrome. Articles exclusively addressing surgical outcomes or employing alternative imaging techniques were systematically excluded. Conclusion: Ultrasound is a valuable diagnostic tool for CTS, offering real-time, high-resolution imaging and quantitative assessment. Techniques such as cross-sectional area analysis, elastography, and speckle tracking that enhance diagnostic accuracy. Future research should standardize thresholds, refine elastographic tools, and integrate 4D imaging for improved evaluation and monitoring.