A total of 178 patients with 202 affected hands were studied prospectively for the management of carpal tunnel syndrome (CTS). Eighty six patients (105 hands) were treated with local steroid injection and 92 patients (97 hands) treated by surgical decompression, the follow up period ranged from 1 to 42 months. The period of relief and the risk of symptoms relapse after each management technique was evaluated. Of the total 86 hands (89%) treated surgically were free of symptoms at the follow up period, only 12 hands (11%) treated by local steroid injection were symptom free after more than one year of follow up. The results showed that local steroid injection have long term effect in the hands with mild symptoms, most were free from daily activity related pain and paresthesia with a duration less than 6 months and with mild median nerve compression in electro diagnostic studies. Surgical release provides better long period of recovery with low rate of relapse, in those hands with severe symptoms and nerve compression that lead to continuous night and daily activity complain, regardless of the duration of symptoms.