TOSM, Delray Beach, Florida, Sports Medicine, Patrick Tyrance, Logo Color 80.

Carpal Tunnel Questionnaire

Carpal Tunnel Questionnaire

Please answer the following questions to see if you are a candidate for Carpal Tunnel Release Using Ultrasound Guidance (CTR-US)

Name
Name
First
Last

Part 1: Symptom Severity (SS)
Please rate the following symptoms experienced over the past two weeks:

1. Pain severity
2. Frequency of pain
3. Numbness severity
4. Frequency of numbness
5. Tingling severity
6. Frequency of tingling
7. Weakness severity
8. Frequency of weakness
9. Severity of nocturnal symptoms
10. Ability to sleep through the night without symptoms
11. Interference with daily activities

Part 2: Functional Status (FS)
Please rate how much difficulty you have had performing the following activities over the past two weeks:

1. Writing
2. Buttoning clothes
3. Holding a book while reading
4. Gripping a cell telephone
5. Opening jars
6. Doing household chores
7. Carrying grocery bags
8. Bathing and dressing
Opt-in
Opt-in