Effectiveness of the Six-Item Carpal Tunnel Symptoms Scale (CTS-6) Questionnaire for the Diagnosis of Carpal Tunnel Syndrome
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Published:
Jun 17, 2024
Keywords:
Carpal tunnel syndrome, CTS-6 scale, carpal tunnel release, reléase, electromyography
Main Article Content
Abstract
Introduction: The Six-Item Carpal Tunnel Symptoms Scale (CTS-6) is a a short 6-item scale based on the Boston Carpal Tunnel Questionnaire (BCTQ). Objective: To evaluate the CTS-6 to identify patients with peripheral neuropathy of the median nerve using surgical criteria.
Materials and Methods: A prospective descriptive observational study was conducted on a group of patientsdiagnosed with carpal tunnel syndrome. The CTS-6 was employed, and the diagnosis was confirmed with electromyography. The patients then underwent surgery. The differences in the CTS-6 score between the various severity levels measured by electromyography were examined.
Results: 106 patients were analyzed and a total of 126 hands were evaluated. 20.75% had bilateral carpal tunnel syndrome. The median CTS-6 score was 21 (min. 16.5; max. 26). According to electromyography results, 24.22% of CTS cases were severe. When comparing the CTS-6 score according to the severity of carpal tunnel syndrome assessed by electromyography, the median CTS-6 score was 16.5 in mild cases, 21 in moderate cases, and 26 in severe cases.
Conclusions: Electromyography revealed a higher CTS-6 score in patients with severe carpal tunnel syndrome. This raises the possibility that it could be used as a noninvasive diagnostic tool in carpal tunnel syndrome to determine which patients would benefit from surgical therapy.
Materials and Methods: A prospective descriptive observational study was conducted on a group of patientsdiagnosed with carpal tunnel syndrome. The CTS-6 was employed, and the diagnosis was confirmed with electromyography. The patients then underwent surgery. The differences in the CTS-6 score between the various severity levels measured by electromyography were examined.
Results: 106 patients were analyzed and a total of 126 hands were evaluated. 20.75% had bilateral carpal tunnel syndrome. The median CTS-6 score was 21 (min. 16.5; max. 26). According to electromyography results, 24.22% of CTS cases were severe. When comparing the CTS-6 score according to the severity of carpal tunnel syndrome assessed by electromyography, the median CTS-6 score was 16.5 in mild cases, 21 in moderate cases, and 26 in severe cases.
Conclusions: Electromyography revealed a higher CTS-6 score in patients with severe carpal tunnel syndrome. This raises the possibility that it could be used as a noninvasive diagnostic tool in carpal tunnel syndrome to determine which patients would benefit from surgical therapy.
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How to Cite
Ferraguti, M. S., Morano, G., Rincón Restrepo, F., & Melo, L. M. (2024). Effectiveness of the Six-Item Carpal Tunnel Symptoms Scale (CTS-6) Questionnaire for the Diagnosis of Carpal Tunnel Syndrome. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 89(3), 226-232. https://doi.org/10.15417/issn.1852-7434.2024.89.3.1822
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Clinical Research
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References
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for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993;75(11):1585-92. https://doi.org/10.2106/00004623-199311000-000024
4. Atroshi I, Lyrén PE, Gummesson C. The 6-item CTS symptoms scale: a brief outcomes measure for carpal tunnel syndrome. Qual Life Res 2009;18(3):347-58. https://doi.org/10.1007/s11136-009-9449-3
5. Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel síndrome. J Bone Joint Surg Am 2008;90(12):2587-93. https://doi.org/10.2106/JBJS.G.01362
6. Alahmad M, Al-Khafaji F, Alahmad MAM, Al-Taie A. Comprehensive assessment of ultrasound’s role in carpal
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9. Glowacki KA, Breen CJ, Sachar K, Weiss AP. Electrodiagnostic testing and carpal tunnel release outcome. J Hand
Surg Am 1996;21(1):117-21. https://doi.org/10.1016/S0266-7681(96)80025-8
10. Rosales RS, Benseny Delgado E, Díez de la Lastra-Bosch I. Evaluation of the Spanish version of the DASH and
carpal tunnel syndrome health-related quality-of-life instruments: cross-cultural adaptation process and reliability. J Hand Surg Am 2002;27(2):334-43. https://doi.org/10.1053/jhsu.2002.30059
11. Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997;96(4):211-7. https://doi.org/10.1111/j.1600-0404.1997.tb00271.x
12. Bland JDP. Carpal tunnel syndrome. Curr Opin Neurol 2005;18(5):581-5. https://doi.org/10.1097/01.wco.0000173142.58068.5a
13. Padua L, Padua R, Aprile I, D’Amico P, Tonali P. Carpal tunnel syndrome: relationship between clinical and patientoriented assessment. Clin Orthop Relat Res 2002;395:128-34. https://doi.org/10.1097/00003086-200202000-00013
14. Grandizio LC, Boualam B, Shea P, Hoehn M, Cove C, Udoeyo IF, et al. The Reliability of the CTS-6 for examiners
with varying levels of clinical experience. J Hand Surg Am 2022;47(6):501e506. https://doi.org/10.1016/j.jhsa.2022.01.024
15. Rosales RS, Martin-Hidalgo Y, Reboso-Morales L, Atroshi I. Reliability and construct validity of the Spanish
version of the 6-item CTS symptoms scale for outcomes assessment in carpal tunnel syndrome. BMC Musculoskelet Disord 2016;17:115. https://doi.org/10.1186/s12891-016-0963-5
16. Ortiz-Corredor F, Calambas N, Mendoza-Pulido C, Galeano J, Díaz-Ruíz J, Delgado O. Factor analysis of Carpal
Tunnel Syndrome Questionnaire in relation to nerve conduction studies. Clin Neurophysiol 2011;122(10):2067-70.
https://doi.org/10.1016/j.clinph.2011.02.030
17. De la Llave-Rincón AI, Fernández-de-las-Peñas C, Laguarta-Val S, Alonso-Blanco C, Martínez-Perez A, Arendt-
Nielsen L, et al. Increased pain sensitivity is not associated with electrodiagnostic findings in women with carpal
tunnel syndrome. Clin J Pain 2011;27(9):747-54. https://doi.org/10.1097/ AJP.0b013e31821c29d3
18. Tamburin S, Cacciatori C, Marani S, Zanette G. Pain and motor function in carpal tunnel syndrome: a clinical,
neurophysiological and psychophysical study. J Neurol 2008;255(11):1636-43. https://doi.org/10.1007/s00415-008-0895-6
19. Sandin KJ, Asch M, Jablecki CK, Kilmer DD, Nuckols TK. Carpal Tunnel Quality Group. Clinical quality measures
for electrodiagnosis in suspected carpal tunnel syndrome. Muscle Nerve 2010;41(4):444-52. https://doi.org/10.1002/mus.21617
20. Graham B, Peljovich AE, Afra R, Cho MS, Gray R, Stephenson J, et al. The American Academy of Orthopaedic
Surgeons Evidence-Based Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome. J Bone Joint
Surg Am 2016;98(20):1750-4. https://doi.org/10.2106/JBJS.16.00719
review. Neurol Sci 2010;31(3):243-52. https://doi.org/10.1007/s10072-009-0213-9
2. Hosseini-Farid M, Schrier JMM, Starlinger J, Amadio PC. Carpal tunnel syndrome treatment and the subsequent
alterations in median nerve transverse mobility. J Ultrasound Med 2021;40(8):1555-68. https://doi.org/10.1002/jum.15535
3. Levine DW, Simmons BP, Koris MJ, Daltroy LH, Hohl GG, Fossel AH, et al. A self-administered questionnaire
for the assessment of severity of symptoms and functional status in carpal tunnel syndrome. J Bone Joint Surg Am 1993;75(11):1585-92. https://doi.org/10.2106/00004623-199311000-000024
4. Atroshi I, Lyrén PE, Gummesson C. The 6-item CTS symptoms scale: a brief outcomes measure for carpal tunnel syndrome. Qual Life Res 2009;18(3):347-58. https://doi.org/10.1007/s11136-009-9449-3
5. Graham B. The value added by electrodiagnostic testing in the diagnosis of carpal tunnel síndrome. J Bone Joint Surg Am 2008;90(12):2587-93. https://doi.org/10.2106/JBJS.G.01362
6. Alahmad M, Al-Khafaji F, Alahmad MAM, Al-Taie A. Comprehensive assessment of ultrasound’s role in carpal
tunnel syndrome in reference to electromyography. Cureus 2021;13(12):e20798. https://doi.org/10.7759/cureus.20798
7. 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):919-24. https://doi.org/10.1016/j.jhsa.2006.03.005
8. American Association of Electrodiagnostic Medicine, American Academy of Neurology, and American Academy of Physical Medicine and Rehabilitation. Practice parameter for electrodiagnostic studies in carpal tunnel síndrome: summary statement. Muscle Nerve 2002;25(6):918-22. https://doi.org/10.1002/mus.10185
9. Glowacki KA, Breen CJ, Sachar K, Weiss AP. Electrodiagnostic testing and carpal tunnel release outcome. J Hand
Surg Am 1996;21(1):117-21. https://doi.org/10.1016/S0266-7681(96)80025-8
10. Rosales RS, Benseny Delgado E, Díez de la Lastra-Bosch I. Evaluation of the Spanish version of the DASH and
carpal tunnel syndrome health-related quality-of-life instruments: cross-cultural adaptation process and reliability. J Hand Surg Am 2002;27(2):334-43. https://doi.org/10.1053/jhsu.2002.30059
11. Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand 1997;96(4):211-7. https://doi.org/10.1111/j.1600-0404.1997.tb00271.x
12. Bland JDP. Carpal tunnel syndrome. Curr Opin Neurol 2005;18(5):581-5. https://doi.org/10.1097/01.wco.0000173142.58068.5a
13. Padua L, Padua R, Aprile I, D’Amico P, Tonali P. Carpal tunnel syndrome: relationship between clinical and patientoriented assessment. Clin Orthop Relat Res 2002;395:128-34. https://doi.org/10.1097/00003086-200202000-00013
14. Grandizio LC, Boualam B, Shea P, Hoehn M, Cove C, Udoeyo IF, et al. The Reliability of the CTS-6 for examiners
with varying levels of clinical experience. J Hand Surg Am 2022;47(6):501e506. https://doi.org/10.1016/j.jhsa.2022.01.024
15. Rosales RS, Martin-Hidalgo Y, Reboso-Morales L, Atroshi I. Reliability and construct validity of the Spanish
version of the 6-item CTS symptoms scale for outcomes assessment in carpal tunnel syndrome. BMC Musculoskelet Disord 2016;17:115. https://doi.org/10.1186/s12891-016-0963-5
16. Ortiz-Corredor F, Calambas N, Mendoza-Pulido C, Galeano J, Díaz-Ruíz J, Delgado O. Factor analysis of Carpal
Tunnel Syndrome Questionnaire in relation to nerve conduction studies. Clin Neurophysiol 2011;122(10):2067-70.
https://doi.org/10.1016/j.clinph.2011.02.030
17. De la Llave-Rincón AI, Fernández-de-las-Peñas C, Laguarta-Val S, Alonso-Blanco C, Martínez-Perez A, Arendt-
Nielsen L, et al. Increased pain sensitivity is not associated with electrodiagnostic findings in women with carpal
tunnel syndrome. Clin J Pain 2011;27(9):747-54. https://doi.org/10.1097/ AJP.0b013e31821c29d3
18. Tamburin S, Cacciatori C, Marani S, Zanette G. Pain and motor function in carpal tunnel syndrome: a clinical,
neurophysiological and psychophysical study. J Neurol 2008;255(11):1636-43. https://doi.org/10.1007/s00415-008-0895-6
19. Sandin KJ, Asch M, Jablecki CK, Kilmer DD, Nuckols TK. Carpal Tunnel Quality Group. Clinical quality measures
for electrodiagnosis in suspected carpal tunnel syndrome. Muscle Nerve 2010;41(4):444-52. https://doi.org/10.1002/mus.21617
20. Graham B, Peljovich AE, Afra R, Cho MS, Gray R, Stephenson J, et al. The American Academy of Orthopaedic
Surgeons Evidence-Based Clinical Practice Guideline on: Management of Carpal Tunnel Syndrome. J Bone Joint
Surg Am 2016;98(20):1750-4. https://doi.org/10.2106/JBJS.16.00719