MDCalc

Carpal Tunnel Syndrome-6 (CTS-6)

Estimates the likelihood of carpal tunnel syndrome (CTS) in adults using symptoms and physical exam findings.

Symptoms and History

Numbness predominately or exclusively in median nerve territory

Sensory symptoms are mostly in the thumb, index, middle, and/or ring fingers

Nocturnal numbness

Symptoms are prominent when patient sleeps; numbness wakes patient from sleep

Physical Examination

Thenar atrophy and/or weakness

The bulk of the thenar area is reduced or manual motor testing shows strength of grade 4 or less

Positive Phalen test

Flexion of the wrist reproduces or worsens symptoms of numbness in the median nerve territory

Loss of 2 point discrimination

A failure to discriminate two points held 5 mm or less apart from one another in the median nerve innervated digits

Positive Tinel sign

Light tapping over the median nerve at the level of the carpal tunnel causing radiating paresthesia into the median nerve innervated digits (not proximally)

Result:

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Advice
  • Results should not replace clinical judgment; integrate this tool with history, exam, risk context (e.g., pregnancy, diabetes, hypothyroidism, repetitive wrist use), and symptom duration.
  • Exclude common mimics, such as cervical radiculopathy, proximal median neuropathy, ulnar neuropathy, and generalized polyneuropathy.
Management

Score ≥12: CTS is more likely.

  • Initiate nonsurgical or surgical interventions, as deemed appropriate.
  • Electrodiagnostic testing is unlikely to add certainty to the diagnosis.

Score <12: CTS is less likely.

  • Consider other diagnoses on the differential.
  • Electrodiagnostic testing may be considered if suspicion for CTS remains high.
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