This study compares the effectiveness of two types of local injections-Hyaluronic Acid (HA) and corticosteroids-for treating mild to moderate idiopathic Carpal Tunnel Syndrome (CTS). Sixty adult patients will be assigned to receive one of the two injections under ultrasound guidance. The goal is to see if HA is as effective as the standard corticosteroid treatment in improving symptoms and nerve function over a 3-month follow-up period.

This is a prospective comparative 3-month follow-up study. Sixty adult patients diagnosed with mild or moderate idiopathic CTS by electro-diagnostic studies will be recruited from the Rheumatology and rehabilitation clinic at Minia University Hospitals, Egypt. Participants will be divided into two groups of 30: one receiving low molecular weight hyaluronic acid and the other receiving corticosteroids, both administered via ultrasound-guided perineural injection. Baseline and follow-up assessments at 1- and 3-months post-injection will include the Boston Carpal Tunnel Syndrome Questionnaire (BCTQ) scores, electro-diagnostic parameters (sensory and motor latencies, CMAP, etc.), and neuromuscular ultrasound examination (median nerve cross-sectional area, flattening ratio, etc.).

Inclusion Criteria:

1. Numbness or pain in the Median Nerve (MN) distribution.
2. Nerve conduction studies (NCS) consistent with CTS as per the AANEM guidelines.
3. An MN cross-sectional area (CSA) at the wrist >12 mm²

Exclusion Criteria:

1. Patients with severe symptoms (indication for surgery).
2. Patients who show improvement on medical treatment.
3. Patients with previous surgical or injectional CTS treatment.
4. Coexistence of brachial plexopathy, or thoracic outlet syndrome.
5. Patients with infection at the site of injection.