Dexmedetomidine, Ozone and Dexamethasone Local Injection in Carpal Tunnel Syndrome for Pain Relief

Inclusion Criteria: * Age from 20 to 60 years. * Both sexes. * Patients with ultrasonographic evidence of mild-to-moderate carpal tunnel syndrome (CTS). * Inclusion criteria will include numbness and pain in the median nerve (MN) distribution persisting for minimum of 3 months , nerve conduction studies (NCS) consistent with carpal tunnel syndrome (CTS) as per the American Association of Neuromuscular and Electro diagnostic Medicine (AANEM) guidelines, and an median nerve (MN) cross-sectional area (CSA)at the wrist \>12 mm2 suggesting mild-to-moderate CTS forms. Exclusion Criteria: * Patient refusal. * Patients with severe symptoms and signs of CTS as identified per the American Association of Neuromuscular and Electro diagnostic Medicine (AANEM) guidelines,\[14\] as this is an indication for surgery, * Patients who show improvement on medical treatment, * Previous surgical or injectional CTS treatment, * Pregnancy ,co existence of brachial plexopathy, or thoracic outlet syndrome, polyneuropathy, radiculopathy and peripheral nerve lesion in upper limb. * Severe cardiovascular disease * Morbid obese patients (body mass index (BMI) of \>35 kg/m2) * Infection at site of injection. * Bleeding diathesis. * History of thyroid deficiency, uncontrolled diabetes mellitus , rheumatoid arthritis and history of glucose-6-phosphate dehydrogenase (G6PD) deficiency * History of Ozone or Dexmedetomidine allergy. * End stage renal and hepatic disease. * History of inflammatory joint , connective tissue disorders, , burns, any local tissue contractures and history of wrist trauma. * Patients who will not consent to completing The visual analogue scale (VAS) for pain or nerve conduction study before and after injection.