1. | How severe is the hand or wrist pain that you have at night? | 6. | Do you have numbness (loss of sensation) in your hand? |
---|---|---|---|
1 I do not have hand or wrist pain at night | 1 No | ||
2 Mild pain | 2 I have mild numbness | ||
3 Moderate pain | 3 I have moderate numbness | ||
4 Severe pain | 4 I have severe numbness | ||
5 Very severe pain | 5 I have very severe numbness | ||
2. | How often did hand or wrist pain wake you up during a typical night in the past two weeks? | 7. | Do you have weakness in your hand or wrist? |
1 Never | 1 No weakness | ||
2 Once | 2 Mild weakness | ||
3 Two or three times | 3 Moderate weakness | ||
4 Four or five times | 4 Severe weakness | ||
5 More than five times | 5 Very severe weakness | ||
3. | Do you typically have pain in your hand or wrist during the daytime? | 8. | Do you have tingling sensations in your hand? |
1 I never have pain during the day | 1 No tingling | ||
2 I have mild pain during the day | 2 Mild tingling | ||
3 I have moderate pain during the day | 3 Moderate tingling | ||
4 I have severe pain during the day | 4 Severe tingling | ||
5 I have very severe pain during the day | 5 Very severe tingling | ||
4. | How often do you have hand or wrist pain during the daytime? | 9. | How severe is numbness (loss of sensation) or tingling at night? |
1 Never | 1 I have no numbness or tingling at night | ||
2 Once or twice a day | 2 Mild | ||
3 Three to five times a day | 3 Moderate | ||
4 More than five times a day | 4 Severe | ||
5 The pain is constant | 5 Very severe | ||
5. | How long, on average, does an episode of pain last during the daytime? | 10. | How often did hand numbness or tingling wake you up during a typical night during the past two weeks? |
1 I never get pain during the day | 1 Never | ||
2 Less than 10 minutes | 2 Once | ||
3 10 to 60 minutes | 3 Two or three times | ||
4 Greater than 60 minutes | 4 Four or five times | ||
5 The pain is constant throughout the day | 5 More than five times | ||
11. | Do you have difficulty with the grasping and use of small objects such as keys or pens? | ||
1 No difficulty | |||
2 Mild difficulty | |||
3 Moderate difficulty | |||
4 Severe difficulty | |||
5 Very severe difficulty |