# CTS-6 (Graham 2006) CTS-6 Status: LIVE Price: $0.005 USDC `GET /api/calc/cts_6` HTML: https://magentlab.com/docs/cts-6 Markdown: https://magentlab.com/docs/cts-6.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Sum the six Graham 2006 CTS-6 caller-assigned flags at their published discrete weights and return the total, the >5 and >12 cutoffs, and the matching band. ## When to use When an agent already has the six Graham 2006 CTS-6 flags assigned and needs the published weighted total, not a carpal-tunnel diagnosis, EMG order, or Boston questionnaire. ## When not to use - Not a medical device and not a CTS diagnosis or EMG order. - magent does not examine the patient. - Each flag is caller-assigned. magent does not infer median-territory numbness, nocturnal symptoms, thenar atrophy, Phalen, two-point discrimination, or Tinel from text or images. - This is Graham 2006 CTS-6 only (discrete weights; max 26). It is not a Boston questionnaire. - Published probability cutoffs are score >5 ≈25% and score >12 ≈80%. Score 5 is not above the 25% cutoff. Score 12 is not above the 80% cutoff. magent does not invent other percent values. ## Formula ``` CTS-6 = 3.5*median_numbness + 4*nocturnal_numbness + 5*thenar_atrophy_or_weakness + 5*phalen_positive + 4.5*two_point_discrimination_loss + 4*tinel_positive; max 26; score > 5 associated with ≈25% probability of CTS; score > 12 associated with ≈80% (Graham 2006) ``` ## Citation [Development and validation of diagnostic criteria for carpal tunnel syndrome](https://doi.org/10.1016/j.jhsa.2006.04.007) Graham B, Regehr G, Naglie G, Wright JG J Hand Surg Am. 2006;31(6):919-924 DOI: [10.1016/j.jhsa.2006.04.007](https://doi.org/10.1016/j.jhsa.2006.04.007) ## Worked example ### All six flags false Given: `median_numbness=false, nocturnal_numbness=false, phalen_positive=false, thenar_atrophy_or_weakness=false, tinel_positive=false, two_point_discrimination_loss=false` 1. No Graham 2006 items present 2. Score = 0.0 (max 26); cts6_band le_5; above_25pct_cutoff false; above_80pct_cutoff false ### Thenar atrophy or weakness only Given: `median_numbness=false, nocturnal_numbness=false, phalen_positive=false, thenar_atrophy_or_weakness=true, tinel_positive=false, two_point_discrimination_loss=false` 1. thenar_atrophy_or_weakness 5 2. Score = 5.0; cts6_band le_5 (score 5 is not above the 25% cutoff) ### Nocturnal numbness and median-territory numbness Given: `median_numbness=true, nocturnal_numbness=true, phalen_positive=false, thenar_atrophy_or_weakness=false, tinel_positive=false, two_point_discrimination_loss=false` 1. median_numbness 3.5 + nocturnal_numbness 4 2. Score = 7.5; cts6_band gt_5_le_12; above_25pct_cutoff true; above_80pct_cutoff false ### All six flags true Given: `median_numbness=true, nocturnal_numbness=true, phalen_positive=true, thenar_atrophy_or_weakness=true, tinel_positive=true, two_point_discrimination_loss=true` 1. 3.5 + 4 + 5 + 5 + 4.5 + 4 2. Score = 26.0 (max 26); cts6_band gt_12 ## Also searched as - CTS-6 - CTS6 - carpal tunnel syndrome 6 - Graham CTS-6 - Graham 2006 CTS - carpal tunnel diagnostic criteria - Phalen Tinel CTS-6 - median neuropathy score - CTS six item - thenar atrophy CTS ## Parameters - `median_numbness` (boolean, required): Numbness predominantly or exclusively in the median nerve territory (Graham 2006, 3.5 if true). true or false as assigned by the caller. magent does not examine the patient. - `nocturnal_numbness` (boolean, required): Nocturnal numbness (Graham 2006, 4 if true). true or false as assigned by the caller. magent does not examine the patient. - `thenar_atrophy_or_weakness` (boolean, required): Thenar atrophy or weakness (Graham 2006, 5 if true). true or false as assigned by the caller. magent does not examine the patient. - `phalen_positive` (boolean, required): Positive Phalen test (Graham 2006, 5 if true). true or false as assigned by the caller. magent does not examine the patient. - `two_point_discrimination_loss` (boolean, required): Loss of two-point discrimination (Graham 2006, 4.5 if true). true or false as assigned by the caller. magent does not examine the patient. - `tinel_positive` (boolean, required): Positive Tinel sign (Graham 2006, 4 if true). true or false as assigned by the caller. magent does not examine the patient. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/cts_6` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "median_numbness": "false", "nocturnal_numbness": "false", "phalen_positive": "false", "thenar_atrophy_or_weakness": "false", "tinel_positive": "false", "two_point_discrimination_loss": "false" }, { "median_numbness": "false", "nocturnal_numbness": "false", "phalen_positive": "false", "thenar_atrophy_or_weakness": "false", "tinel_positive": "false", "two_point_discrimination_loss": "false" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/cts-6 Example 200: ```json { "count": 2, "path": "/api/calc/cts_6", "items": [ { "components": [ { "factor": "median_numbness", "points": 0.0, "present": false }, { "factor": "nocturnal_numbness", "points": 0, "present": false }, { "factor": "thenar_atrophy_or_weakness", "points": 0, "present": false }, { "factor": "phalen_positive", "points": 0, "present": false }, { "factor": "two_point_discrimination_loss", "points": 0.0, "present": false }, { "factor": "tinel_positive", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Graham B, Regehr G, Naglie G, Wright JG", "doi": "10.1016/j.jhsa.2006.04.007", "id": "graham-2006", "pmid": "16886290", "source": "J Hand Surg Am. 2006;31(6):919-924", "title": "Development and validation of diagnostic criteria for carpal tunnel syndrome" }, "formula": "cts_6", "formula_expression": "CTS-6 = 3.5*median_numbness + 4*nocturnal_numbness + 5*thenar_atrophy_or_weakness + 5*phalen_positive + 4.5*two_point_discrimination_loss + 4*tinel_positive; max 26; score > 5 associated with ≈25% probability of CTS; score > 12 associated with ≈80% (Graham 2006)", "max_score": 26, "score": 0.0, "above_25pct_cutoff": false, "above_80pct_cutoff": false, "cts6_band": "le_5" }, { "components": [ { "factor": "median_numbness", "points": 0.0, "present": false }, { "factor": "nocturnal_numbness", "points": 0, "present": false }, { "factor": "thenar_atrophy_or_weakness", "points": 0, "present": false }, { "factor": "phalen_positive", "points": 0, "present": false }, { "factor": "two_point_discrimination_loss", "points": 0.0, "present": false }, { "factor": "tinel_positive", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Graham B, Regehr G, Naglie G, Wright JG", "doi": "10.1016/j.jhsa.2006.04.007", "id": "graham-2006", "pmid": "16886290", "source": "J Hand Surg Am. 2006;31(6):919-924", "title": "Development and validation of diagnostic criteria for carpal tunnel syndrome" }, "formula": "cts_6", "formula_expression": "CTS-6 = 3.5*median_numbness + 4*nocturnal_numbness + 5*thenar_atrophy_or_weakness + 5*phalen_positive + 4.5*two_point_discrimination_loss + 4*tinel_positive; max 26; score > 5 associated with ≈25% probability of CTS; score > 12 associated with ≈80% (Graham 2006)", "max_score": 26, "score": 0.0, "above_25pct_cutoff": false, "above_80pct_cutoff": false, "cts6_band": "le_5" } ] } ``` ## Response fields - `formula` (string): cts_6 - `formula_expression` (string): Exact expression used - `score` (number): CTS-6 points 0.0-26.0 (float; no rounding) - `max_score` (integer): 26 - `cts6_band` (string): le_5 (score ≤5), gt_5_le_12 (5 < score ≤12), or gt_12 (score >12). Graham 2006 cutoffs. - `above_25pct_cutoff` (boolean): true iff score > 5 (Graham 2006 ≈25% probability of CTS). Score 5 is not above. - `above_80pct_cutoff` (boolean): true iff score > 12 (Graham 2006 ≈80% probability of CTS). Score 12 is not above. - `components` (array): Per-flag Graham 2006 weights - `citation` (object): Graham J Hand Surg Am 2006 citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "components": [ { "factor": "median_numbness", "points": 0.0, "present": false }, { "factor": "nocturnal_numbness", "points": 0, "present": false }, { "factor": "thenar_atrophy_or_weakness", "points": 0, "present": false }, { "factor": "phalen_positive", "points": 0, "present": false }, { "factor": "two_point_discrimination_loss", "points": 0.0, "present": false }, { "factor": "tinel_positive", "points": 0, "present": false } ], "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Graham B, Regehr G, Naglie G, Wright JG", "doi": "10.1016/j.jhsa.2006.04.007", "id": "graham-2006", "pmid": "16886290", "source": "J Hand Surg Am. 2006;31(6):919-924", "title": "Development and validation of diagnostic criteria for carpal tunnel syndrome" }, "formula": "cts_6", "formula_expression": "CTS-6 = 3.5*median_numbness + 4*nocturnal_numbness + 5*thenar_atrophy_or_weakness + 5*phalen_positive + 4.5*two_point_discrimination_loss + 4*tinel_positive; max 26; score > 5 associated with ≈25% probability of CTS; score > 12 associated with ≈80% (Graham 2006)", "max_score": 26, "score": 0.0, "above_25pct_cutoff": false, "above_80pct_cutoff": false, "cts6_band": "le_5" } ``` ## Errors - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - None ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.