Carpal Tunnel Syndrome-6 (CTS-6) Diagnostic Tool
CTS-6 (Graham 2006): six weighted clinical criteria for carpal tunnel syndrome — numbness in the median territory, nocturnal numbness, thenar atrophy or weakness, Phalen test, loss of 2-point discrimination and Tinel sign. Score 0–26; ≥ 12 means CTS is likely.
Score interpretation
CTS-6 below 5 — about 25% probability of carpal tunnel syndrome.
→ Consider alternative diagnoses (cervical radiculopathy, thoracic outlet syndrome, peripheral neuropathy, de Quervain's tenosynovitis); review MRI cervical spine if radiculopathy suspected; physiotherapy for non-specific hand/wrist pain; reassess if symptoms progress
CTS-6 5–11.5 — below the ≥ 12 threshold; diagnosis uncertain.
→ Nerve conduction studies (NCS/EMG) to confirm diagnosis; in the interim: trial of wrist splints at night (6–12 weeks); corticosteroid injection if diagnosis likely; physiotherapy for median nerve mobilisation; modify aggravating activities; ergonomic review
CTS-6 ≥ 12 — about 80% probability of carpal tunnel syndrome.
→ Diagnosis clinically established — NCS can confirm but may not be necessary before treatment; night splints; if mild-moderate: corticosteroid injection (Adults: methylprednisolone 40 mg. Children: use a children's formulary.) relieves symptoms in >80%; if moderate-severe or failed conservative treatment: refer to hand surgery for carpal tunnel decompression; if thenar atrophy: prioritise surgical referral; avoid long-term activity restriction
Interpretation bands for the CTS-6. Apply clinical judgement and local guidance.
References
- Graham B, Regehr G, Naglie G, Wright JG. Development and validation of diagnostic criteria for carpal tunnel syndrome. J Hand Surg Am. 2006;31(6):919-924.
- Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel syndrome. J Bone Joint Surg Am. 2008;90(12):2587-2593.
Related
Curated clinical cross-links plus same-class fallbacks.
- Oxycodone with naloxone · Strong opioid + peripheral opioid antagonist
- Tetracosactide · Synthetic ACTH (short Synacthen test)
- Aciclovir 800mg Tablets (Ramsay Hunt Syndrome / Herpes Zoster Oticus) · Antiviral — nucleoside analogue (herpes zoster treatment)
- Loperamide · Opioid Receptor Agonist (Peripheral — Antidiarrhoeal)
- Pramipexole (Restless Legs Syndrome — Elderly) · Dopamine Agonist (D2/D3 Receptor)
- Domperidone · Prokinetic Antiemetic (Peripheral Dopamine Antagonist)
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.
