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Carpal Tunnel Syndrome Symptom Progress Chart

Daily Monitoring Tool for CTS Management

Orthopedics

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Template Content

Last updated: Mar 24, 2025

Patient Information

Name: _________________ Start Date: ____________

Daily Symptom Tracker

Rate symptoms from 0 (none) to 10 (severe)

Week: _______________

Symptoms Mon Tue Wed Thu Fri Sat Sun
Numbness
Tingling
Pain
Weakness
Night Discomfort

Activity Log

Daily Activities Affecting Symptoms

  • Computer use: ____ hours
  • Repetitive hand movements: ____ hours
  • Wrist brace worn: □ Yes □ No
  • Hand exercises completed: □ AM □ PM

Treatment Notes

  • Ice/heat therapy used: □ Yes □ No
  • NSAIDs taken: □ Yes □ No
  • Other medications: ________________

Weekly Progress Summary

Overall symptom trend: □ Improving □ Unchanged □ Worsening

Notes: _________________________

Healthcare Provider Review

Date: ____________ Comments: _____________________ Next appointment: ______________

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