In addition to the factors noted above, women are approximately three times more likely to develop CTS compared to men. The precise reason for this is unknown but may be related to the relative size of the wrist or hormonal factors. CTS is also more likely to occur in the dominant hand, likely related to relative overuse. In patients who have symptoms in both hands, the dominant hand is usually more severely affected. Although individuals in all occupations may develop CTS, those who work on assembly lines or in manufacturing have a higher risk of developing CTS than those working in primarily desk positions. Finally, obesity has also been identified as  a risk factor for both the development of CTS and the need for carpal tunnel release.