CARPAL TUNNEL SYNDROME SCORE

This questionnaire has been designed to provide you and your treating physician with information regarding the severity of your wrist and hand symptoms when considering carpal tunnel syndrome severity.

Please answer every question and select the option that MOST ACCURATELY applies to you and your symptoms.

Note

This questionnaire should not be utilized in place of a qualified medical professional. All users agree to the disclaimer, which can be found at www.epainhealth.com/disclaimer, when using any content made available through this site. All information provided on www.epainhealth.com is for informational purposes only.

Carpal Tunnel Syndrome Assessment

How severe is the hand or wrist pain that you have at night?*

Normal

Slight

Medium

Severe

Very Serious

How often did hand or wrist pain wake you up during a typical night in the past two weeks? *

Normal

One

2 to 3 times

4 to 5 times

More than 5 times

Do you typically have pain in your hand or wrist during the daytime? *

No pain

Slight

Medium

Severe

Very Serious

How often do you have hand or wrist pain during daytime? *

Normal

1-2 times/day

3-5 times/day

More than 5 times/day

Continuous

How long on average does an episode of pain last during the daytime? *

Normal

Less than 10 minutes

From 10 to 60 minutes

More than 60 minutes

Continuous

Do you have numbness (loss of sensation) in your hand? *

Normal

Slight

Medium

Severe

Very Serious

Do you have weakness in your hand or wrist? *

Normal

Slight

Medium

Severe

Very Serious

Do you have tingling sensations in your hand? *

Normal

Slight

Medium

Severe

Very Serious

How severe is numbness (loss of sensation) or tingling at night? *

Normal

Slight

Medium

Severe

Very Serious

How often did hand numbness or tingling wake you up during a typical night during the past two weeks? *

Normal

Once

2 to 3 times

4 to 5 times

More than 5 times

Do you have difficulty with the grasping and use of small objects such as keys or pens? *

Without difficulty

Little difficulty

Moderately difficult

Very difficult

Writing *

No difficulty

Little difficulty

Moderate difficulty

Intense difficulty