Inclusion Criteria:  patients with clinical diagnosis of mild to moderate CTS and confirmed by neurophysiological studies.  The clinical symptoms and signs of CTS are as follows:  sensory symptoms in the form of paresthesia, dysesthesia, pain and numbness of the hand in the distribution of median nerve which was more nocturnal, postural or related to hand overuse and relieved by frequent shaking of the hand motor symptoms in the form of decreased strength of the thenar muscles positive Phalen and/or Tinel sign.  Exclusion Criteria:  Pregnancy Cancer hypothyroidism systemic infection history of polyneuropathy cervical radiculopathy brachial plexopathy thoracic outlet syndrome history of previous carpal tunnel open surgery or local steroid injection and severe CTS (confirmed by el electrophysiological studies)