Introduction: Occupation-related Carpal tunnel syndrome represents one of the major health problems among workers in various occupations throughout the world that possess a complex symptoms resulting from compressing the median nerve at the carpal tunnel. Farmers in Egypt are known to use the traditional manual milking of their cattle which needs bilateral repetitive hand movements. Aim of the work: To determine the prevalence and severity of CTS among farmers who performed hand-milking task of cattle and correlate these findings with working years and work duration per hours. Materials and methods: A structured questionnaire was used to determine demographics; work history, present medications and history of any chronic illness. Clinical examination for CTS symptoms as nocturnal exacerbation, Phalen sign, Tinel sign, sensory hyperalgesia, thenar atrophy and thenar weakness. Electrophysiologic studies were done for 240 female farmers, where half of them were milking their cattle manually the other half is used as control. Both groups are matched for age, and Body Mass Index (BMI). Results: The prevalence and clinical severity of CTS were significantly higher among female farmers who milk their cattle than non milkers in both hands (P<0.001), The median nerve motor and sensory conductive study was significantly higher among milkers than non milkers farmers (P value<0.001). The electrophysiological findings were significantly correlated with the longer years of work and longer working hours. Conclusion: These findings suggest that CTS is a significant occupational health issue for farmers that continue the traditional methods of manual milking. Introduction of automated milking machines may help to reduce this problem among the coming generations of the Egyptian farmers who represents a noticeable part of our community