Inclusion Criteria:  A confirmed diagnosis of carpal tunnel syndrome based on Evidence for Surgical Treatment issued by the British Society for Surgery of the Hand Symptoms of carpal tunnel syndrome had lasted>2 months or inadequate responses to the non-surgical treatments≥3 months moderate to severe symptoms.  Exclusion Criteria:  mild symptoms or prior injuries to the extremity bilateral wrists involved, a combined nerve compression, gout, diabetes or chronic renal failure.