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CTS-6 (carpal tunnel syndrome)

Estimates carpal tunnel syndrome probability from two symptoms and four examination findings in adults with hand complaints.

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Check the population, units and version. The result shows the formula or classification; it does not make an automatic treatment decision.

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Method · Limits of application

CTS-6/Graham 2006: 6 weighted carpal tunnel criteria; clinical examination

Graham’s 2006 development used expert consensus and case histories combining clinical criteria; validation described in the abstract compared model probabilities with judgments from another panel. That design does not by itself establish performance against electrophysiological testing in every clinical population. The six-item score, its cutoff and age range must be checked in the full method.

Conditions of use

Check the population, units, inclusion and exclusion criteria, and version in the original source. A result alone does not establish a diagnosis, discharge decision or prescription.

Documented parameters

Numbness predominantly or exclusively in the median nerve distribution
Nocturnal numbness
Thenar muscle atrophy and/or weakness
Positive Phalen test
Loss of two-point discrimination (> 6 mm)
Positive Tinel sign over the carpal tunnel

4/4 reference cases checked. Numerical tests are not clinical validation.

Sources and documentation

Documented formula

Transcribed from the source or a recorded revision; this is not a clinical recommendation.

Sum present items: median-nerve-distribution numbness 3.5; nocturnal numbness 4; thenar atrophy/weakness 5; positive Phalen 5; loss of two-point discrimination 4.5; positive Tinel 4. Total 0–26.

References

Identifier: cts-6

Original clinical content: Brazilian Portuguese.

Method version

CTS-6/Graham 2006: 6 weighted carpal tunnel criteria; clinical examination

cts-6@native-2026-10-05+ce2c99f8d150

Source for the active edition

The bibliographic edition identifies the source. By itself, it proves neither full conformity of the formula nor clinical approval.

Synthetic cases checked (4)

Synthetic cases for checking the implementation, with no patient data.

Case 1

reference-001

Inputs

Numbness predominantly or exclusively in the median nerve distribution: Yes
Nocturnal numbness: No
Thenar muscle atrophy and/or weakness: No
Positive Phalen test: No
Loss of two-point discrimination (> 6 mm): No
Positive Tinel sign over the carpal tunnel: No

{
  "dorm": true,
  "noturna": false,
  "atrofia": false,
  "phalen": false,
  "dpp": false,
  "tinel": false
}

Expected result

{
  "score": 3.5,
  "level": "low"
}

Actual result

{
  "score": 3.5
}

Case 2

reference-002

Inputs

Nocturnal numbness: Yes
Positive Phalen test: Yes
Numbness predominantly or exclusively in the median nerve distribution: No
Thenar muscle atrophy and/or weakness: No
Loss of two-point discrimination (> 6 mm): No
Positive Tinel sign over the carpal tunnel: No

{
  "noturna": true,
  "phalen": true,
  "dorm": false,
  "atrofia": false,
  "dpp": false,
  "tinel": false
}

Expected result

{
  "score": 9,
  "level": "mid"
}

Actual result

{
  "score": 9
}

Case 3

reference-003

Inputs

Numbness predominantly or exclusively in the median nerve distribution: Yes
Nocturnal numbness: Yes
Positive Tinel sign over the carpal tunnel: Yes
Thenar muscle atrophy and/or weakness: No
Positive Phalen test: No
Loss of two-point discrimination (> 6 mm): No

{
  "dorm": true,
  "noturna": true,
  "tinel": true,
  "atrofia": false,
  "phalen": false,
  "dpp": false
}

Expected result

{
  "score": 11.5,
  "level": "mid"
}

Actual result

{
  "score": 11.5
}

Case 4

reference-004

Inputs

Nocturnal numbness: Yes
Positive Phalen test: Yes
Positive Tinel sign over the carpal tunnel: Yes
Numbness predominantly or exclusively in the median nerve distribution: No
Thenar muscle atrophy and/or weakness: No
Loss of two-point discrimination (> 6 mm): No

{
  "noturna": true,
  "phalen": true,
  "tinel": true,
  "dorm": false,
  "atrofia": false,
  "dpp": false
}

Expected result

{
  "score": 13,
  "level": "high"
}

Actual result

{
  "score": 13
}

Code and reproducibility

This tool’s code on GitHub

Download code and tests

Sources, version and reproduction instructions

README

Local installation

Code license: Apache-2.0

Guidelines and conditions

This repository’s license applies to the code. Third-party instruments, questionnaires, data and models remain subject to their owners’ conditions.

The code tests are technical checks. Clinical approval and professional translation review are recorded separately.

Relationship with cancer research

General context — relationship to be defined

A resource for general clinical contexts. This edition does not assign a specific oncological relationship; selecting it for a study requires a justified question, population and purpose.