Inclusion Criteria:  age older than 18 years positive Tinel's sign or positive Phalen's sign pain or paresthesia in the median nerve course pain or paresthesia aggravated at night moderate CTS according to the American Association of Electrodiagnostic Medicine (AAEM) guidelines  Exclusion Criteria:  metabolic diseases (including diabetes mellitus, thyroid and chronic kidney diseases) rheumatoid arthritis wrist trauma pregnancy corticosteroid treatment in the last 3 months physical or medical treatment in the last month