Carpal Tunnel Syndrome-6 (CTS-6) Diagnostic Tool
6-item clinical prediction rule for diagnosing carpal tunnel syndrome (CTS) without the need for nerve conduction studies (NCS). Items: nocturnal symptoms, hand diagram, wrist ratio index, Phalen's test, loss of 2-point discrimination, weakness/atrophy. Score ≥12 = high likelihood CTS.
Score interpretation
CTS-6 <3 — carpal tunnel syndrome unlikely
→ 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 3–6 — intermediate probability; further investigation warranted
→ 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 ≥7 — high 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 (methylprednisolone 40 mg) 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
- Wainner RS et al. Reliability and diagnostic accuracy of the clinical examination and patient self-report measures for cervical radiculopathy. Spine. 2003;28(1):52–62.
- Mehta A et al. Systematic review and meta-analysis of the CTS-6 for carpal tunnel syndrome diagnosis. J Hand Surg Eur. 2017;42(9):933–941.
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.