Inclusion Criteria:  CTS diagnosis was based on the presence of at least one of the following symptoms  numbness, tingling pain, or paresthesia in the median nerve distribution precipitation of these symptoms by repetitive hand activities, which could be relieved by resting, rubbing, and shaking the hand nocturnal awakening by such sensory symptoms. The diagnosis was often supported by a positive Tinel sign Confirmed by the presence of one or more of the following standard electrophysiologic criteria  (1) prolonged distal motor latency (DML) to the abductor pollicis brevis (APB) (abnormal Z4.7 ms, stimulation over the wrist, 8 cm proximal to the active electrode) (2) prolonged antidromic distal sensory latency (DSL) to the second digit (abnormal Z3.1 ms;stimulation over the wrist, 14 cm proximal to the active electrode) (3) prolonged antidromic wrist-palm sensory nerve conduction velocity (W-P SNCV) at a distance of 8 cm (W-P SNCV, abnormal <45 m/s).9-  Exclusion Criteria:  Symptoms occurring less than 3 months before the study (to exclude patients who might have spontaneous resolution of symptoms) severe CTS that had progressed to visible muscle atrophy clinical or electrophysiologic evidence of accompanying conditions that could mimic CTS or interfere with its evaluation, such as cervical radiculopathy, proximal median neuropathy, or significant polyneuropathy evidence of obvious underlying etiologic factors of CTS such as diabetes mellitus, rheumatoid arthritis, hypothyroidism (acromegaly), pregnancy, alcohol abuse or drug usage (steroids or drugs acting through the central nervous system), and suspected malignancy or inflammation or autoimmune disease documented as underlying causes of CTS cognitive impairment interfering with the subject's ability to follow instructions and describe symptoms