Although many approaching methods to carpal tunnel injection have been described, there is no sufficient evidence of one superior technique compared to the others. To compare the degree of symptom improvement between radial and ulnar approaches in US-guided local steroid injection in management of carpal tunnel syndrome. A randomized clinical trial study that conducted at Private Nursing Home Hospital / Medical City / Baghdad for a period of one year from 1st Jun. 2020. to 1st Jun. 2021. It included 40 adult patients complained from mild to moderate carpal tunnel syndrome and scheduled for single shot of corticosteroid injection under US-guided in-plane approach and randomly allocated to one of two groups: Group R included 20 patients received 40 mg depomedrol injection (1 ml) from the radial side and group U included 20 patients received 40 mg depomedrol injection (1 ml) from the ulnar side. Patients were assessed before the injection and at follow-up visits after 2, 6 and 8 weeks by visual analogue score for pain and by Boston carpal tunnel questionnaire for subjective efficacy. In this study, means of VAS, BQSS, and BQFS were significantly reduced in both groups after 2, 6, and 8 weeks and significantly lower in group R than that in group U after eight weeks. Both approaches are effective in the management of carpal tunnel syndrome regarding pain management and subjective improvement with more efficacy and better outcome for radial approach in prolonged management.