Radiofrequency, Perineural Injection, Idiopathic Carpal Tunnel Syndrome

Aim of the study The aim of the study is to evaluate the role of pulsed radiofrequency versus platelet rich plasma injection in treatment of idiopathic mild to moderate carpal tunnel syndrome Patients will be classified into three equal groups using randomized closed envelop method into three groups. Control Group ( n=25):Patients will receive median nerve perineural injection of bupivacaine with mehylprednisolone under ultrasound guidance. PRF Group ( n=25):Patients will receive median nerve pulsed radiofrequency (PRF) and median nerve perineural injection of bupivacaine under ultrasound guidance PRP Group (n=25): Patients will receive median nerve perineural injection of platelet-rich plasma (PRP) under ultrasound guidance Measurements (will be done before the procedure, one week ,two month and four months after procedure except SNCV and serum CRP and TNF α (tumor necrosis factor alpha)will be done before the procedure and after four months only): 1. VAS (visual analogue pain scale) 2. BCTQ (Boston carpal tunnel Questionnaire) 3. Degree of paresthesia tested by Reverse Phalen's test. 4. CSA (cross sectional area)0 of the median nerve will be measured by the same pain therapist involved in the study. 5. SNCV (nerve conduction velocity study): performed by same physiotherapist not involved in the study before and after intervention. 6. Serum Tumor necrosis factor alpha (TNF α). 7. C-reactive protein (CRP) 8. Complications will be recorded and managed. Items 1,2 and 3 will be measured by a pain therapist not involved in this study