The Combined Shoulder Assessment Looking for a paper version? Download here: Shoulder Assessment (PDF) PainHow would you describe the pain you usually get from your shoulder?*NoneMildModerateSevereUnbearableHow would you describe the worst pain from your shoulder?*NoneMildModerateSevereUnbearableHow would you describe tingling in your arm, shoulder or hand?*NoneMildModerateSevereUnbearableHow much difficulty have you had sleeping due to your shoulder?*No difficultyMild difficultyModerate difficultySevere difficultyUnableFunctionHow much difficulty have you had carrying shopping bags due to your shoulder?*No DifficultyMild DifficultyModerate DifficultySevere DifficultyUnableHow much difficulty have you had dressing yourself due to your shoulder*No DifficultyMild DifficultyModerate DifficultySevere DifficultyUnableCan you hang clothes in a wardrobe with your affected arm?*Yes easilyMild DifficultyModerate DifficultySevere DifficultyUnableCan you use a knife and fork at the same time?*Yes easilyMild DifficultyModerate DifficultySevere DifficultyUnableActivitiesHow has your shoulder interfered with normal occupational activities?*Not at allSlightlyModeratelyQuite a bitExtremelyHow has your shoulder interfered with normal social activities?*Not at allSlightlyModeratelyQuite a bitExtremelyHow has your shoulder limited your leisure and recreational activities?*Not at allSlightlyModeratelyQuite a bitExtremelyHave you found difficulty in playing sport / instrument due to pain in your shoulder, arm or hand?*Not at allSlightlyModeratelyQuite a bitExtremelyAbductionLook at the illustrations below and try to carry out the movements one by one.*Arm out to side 0-30° angleArm out to side 31-60° angleArm out to side 61-90° angleArm out to side 91-120° angleArm out to side 121-150° angleArm out to side more then 150° angleForward FlexionLook at the illustrations below and try to carry out the movements one by one.*Arm forwards 0-30° angleArm forwards 31-60° angleArm forwards 61-90° angleArm forwards 91-120° angleArm forwards 121-150° angleArm forwards greater then 150° angleExternal RotationLook at the illustrations below and try to carry out the movements one by one.*Hand behind head, elbow forwardHand behind head, elbow backHand on top of head, elbow forwardHand on top of head, elbow backFull elevationInternal RotationLook at the illustrations below and try to carry out the movements one by one.*Arm next to thighBack of hand on buttockBack of hand on waist lineBack of hand on lower backBack of hand about half way up backBack of hand between shoulder bladesStrength of Abduction (lb)(To 90 degrees abduction or highest level patient can achieve)*01-34-67-910-1213-1516-1819-2122-24>25ScoresEquivalent Constant PtsEquivalent Oxford PtsEquivalent QDash Pts Δ This iframe contains the logic required to handle Ajax powered Gravity Forms. The Combined Shoulder Assessment Looking for a paper version? Download here: Shoulder Assessment (PDF) PainHow would you describe the pain you usually get from your shoulder?*NoneMildModerateSevereUnbearableHow would you describe the worst pain from your shoulder?*NoneMildModerateSevereUnbearableHow would you describe tingling in your arm, shoulder or hand?*NoneMildModerateSevereUnbearableHow much difficulty have you had sleeping due to your shoulder?*No difficultyMild difficultyModerate difficultySevere difficultyUnableFunctionHow much difficulty have you had carrying shopping bags due to your shoulder?*No DifficultyMild DifficultyModerate DifficultySevere DifficultyUnableHow much difficulty have you had dressing yourself due to your shoulder*No DifficultyMild DifficultyModerate DifficultySevere DifficultyUnableCan you hang clothes in a wardrobe with your affected arm?*Yes easilyMild DifficultyModerate DifficultySevere DifficultyUnableCan you use a knife and fork at the same time?*Yes easilyMild DifficultyModerate DifficultySevere DifficultyUnableActivitiesHow has your shoulder interfered with normal occupational activities?*Not at allSlightlyModeratelyQuite a bitExtremelyHow has your shoulder interfered with normal social activities?*Not at allSlightlyModeratelyQuite a bitExtremelyHow has your shoulder limited your leisure and recreational activities?*Not at allSlightlyModeratelyQuite a bitExtremelyHave you found difficulty in playing sport / instrument due to pain in your shoulder, arm or hand?*Not at allSlightlyModeratelyQuite a bitExtremelyAbductionLook at the illustrations below and try to carry out the movements one by one.*Arm out to side 0-30° angleArm out to side 31-60° angleArm out to side 61-90° angleArm out to side 91-120° angleArm out to side 121-150° angleArm out to side more then 150° angleForward FlexionLook at the illustrations below and try to carry out the movements one by one.*Arm forwards 0-30° angleArm forwards 31-60° angleArm forwards 61-90° angleArm forwards 91-120° angleArm forwards 121-150° angleArm forwards greater then 150° angleExternal RotationLook at the illustrations below and try to carry out the movements one by one.*Hand behind head, elbow forwardHand behind head, elbow backHand on top of head, elbow forwardHand on top of head, elbow backFull elevationInternal RotationLook at the illustrations below and try to carry out the movements one by one.*Arm next to thighBack of hand on buttockBack of hand on waist lineBack of hand on lower backBack of hand about half way up backBack of hand between shoulder bladesStrength of Abduction (lb)(To 90 degrees abduction or highest level patient can achieve)*01-34-67-910-1213-1516-1819-2122-24>25ScoresEquivalent Constant PtsEquivalent Oxford PtsEquivalent QDash Pts Δ This iframe contains the logic required to handle Ajax powered Gravity Forms.
