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Carpal Tunnel Quiz
First Name
First
Location
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Outside the US
Occupation and/or hobbies which may affect your symptoms
Select your age:
Less than 19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76+
Do you have any of the following symptoms in your hand(s)? Choose all that apply.
Left Hand
Numbness
Tingling
Burning
Pain
Other
None
Right Hand
Numbness
Tingling
Burning
Pain
Other
None
Hidden
Left Hand Min/Max
Hidden
Right Hand Min/Max
Please describe the symptoms in your left hand:
Please describe the symptoms in your right hand:
Look at the diagrams below and choose all the areas on the diagram where you feel numbness, tingling, burning, or pain in your hand(s): Choose all that apply.
Left Hand
A. Thumb
B. Index
C. Middle
D. Ring
E. Pinky
F. Palm (thumb side)
G. Palm (pinky side)
H. Back of hand (dorsum)
Right Hand
A. Thumb
B. Index
C. Middle
D. Ring
E. Pinky
F. Palm (thumb side)
G. Palm (pinky side)
H. Back of hand (dorsum)
Hidden
Right Hand (2) Min/Max
Hidden
Left Hand (2) Min/Max
Look at the diagrams below and choose all the areas on the diagram where you feel symptoms other than numbness, tingling, burning, or pain in your hand(s): Choose all that apply.
Left Hand
A. Thumb
B. Index
C. Middle
D. Ring
E. Pinky
F. Palm (thumb side)
G. Palm (pinky side)
H. Back of hand (dorsum)
Right Hand
A. Thumb
B. Index
C. Middle
D. Ring
E. Pinky
F. Palm (thumb side)
G. Palm (pinky side)
H. Back of hand (dorsum)
Hidden
Right Hand (3) Min/Max
Hidden
Left Hand (3) Min/Max
Are the symptoms in your hand(s) worsened by any of the following?: Choose all that apply.
Left Hand
Sleeping
Driving
Holding a phone
Typing
Heavy physical use of hands (such as yard work)
None
Other
Right Hand
Sleeping
Driving
Holding a phone
Typing
Heavy physical use of hands (such as yard work)
None
Other
Please describe the symptoms in your left hand:
Please describe the symptoms in your right hand:
Hidden
Right Hand (4) Min/Max
Hidden
Left Hand (4) Min/Max
Have you ever been diagnosed with carpal tunnel syndrome?
Left Hand
Yes
No
Right Hand
Yes
No
Have you ever had an abnormal Nerve Conduction Study/EMG or “nerve test” of your arm(s)?
Left
Yes
No
Right
Yes
No
Do you have a history of neck trouble?
Yes
No
Were the symptoms in your hand(s) brought on by a forceful injury such as a fall or accident?
Left Hand
Yes
No
Right Hand
Yes
No
Do you have numbness in your feet or hands (diabetic neuropathy) as a result of diabetes?
Left
Yes
No
Right
Yes
No
Hidden
Right Hand Total
Hidden
Left Hand Total
Hidden
Right Hand Very Likely
Hidden
Left Hand Very Likely
Hidden
Right Hand Probable
Hidden
Left Hand Probable
Hidden
Right Hand Possible
Hidden
Left Hand Possible
Hidden
Right Hand Unlikely
Hidden
Left Hand Unlikely
Hidden
Carpal Tunnel + Probable Cubital Tunnel
Hidden
Probable Cubital Tunnel rather than Carpal Tunnel
Hidden
Very Likely
Hidden
Probable
Hidden
Possible
Hidden
Unlikely
Phone
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Email
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Comments
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