Carpal tunnel questionnaire form 2026

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  1. Click ‘Get Form’ to open the carpal tunnel questionnaire in the editor.
  2. Begin by entering your name and the date at the top of the form. This personal information is essential for tracking your responses.
  3. Read through each question carefully, focusing on your symptoms over the past two weeks. For each question, circle one answer that best reflects your experience.
  4. For the severity and functional scale questions, rate your pain and symptoms from 1 (None or Never) to 5 (Very Severe). Be honest to ensure accurate assessment.
  5. In the comments section at the end of the form, feel free to add any additional notes or observations regarding your symptoms.
  6. Once completed, review your answers for accuracy before saving or exporting the document directly from our platform.

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This instrument consists of four subscales identifying domains commonly impaired in MS: attention, retrospective memory, prospective memory, and planning and organization. The combined subscales yield a total score ranging from 0 to 80, with a higher score indicating greater perceived cognitive impairment.
Phalen test: Sit or stand with your elbows bent at right angles and your forearms parallel to the floor. Press the backs of your hands together, pointing your fingers downward, and hold this position for about 60 seconds. If this posture increases numbness, tingling, or pain in your hand, it could be a sign of CTS.
The Symptom Severity Scale (SSS) with 11 questions is scored on a Likert scale of 1-5 and the Functional Status Scale (FSS) with 8 questions is scored from 1-5 with 1 as no difficulty and 5 as difficult.
The Carpal Tunnel Questionnaire (CTQ) is the most frequently used outcome measure for carpal tunnel syndrome. First published in 1993 by Levine et al., the CTQ is comprised of two modules: an 11-item Symptom Specific Scale (SSS) and an 8-item Functional Status Scale (FSS).
The Emotion Regulation Questionnaire Respondents answers are scored on a 7-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). The scoring takes the average of all the scores in each subscale of cognitive reappraisal and expressive suppression.

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Scoring: Total Score = Sum of all 21 items with No = 0, Yes = 1. Distress Score= Sum of all 21 items with No = 0; Yes: strongly disagree = 1, disagree = 2, neutral = 3, agree = 4, strongly agree = 5.
Psychological Capital Questionnaire Scoring An overall PsyCap score is calculated by taking the mean of all the items in the PCQ. Scales include reverse-scored items. The 6-point Likert scale for all PCQ scales is as follows: Strongly Disagree.

boston carpal tunnel questionnaire pdf