Please place a mark on the line that best represents your experience during the last week attributable to your shoulder problem.
  • Name*full name
    0
  • Email*a valid email address
    1
  • 1. Pain Scale
    2
  • Drag the slider to indicate the number that best describes your pain where: 0 = no pain and 10 = the worst pain imaginable*
    At its worst?00 - 00
    When lying on the involved side?00 - 00
    Reaching for something on a high shelf?00 - 00
    Touching the back of your neck?00 - 00
    Pushing with the involved arm?00 - 00
    3
  • 2. Disability scale How much difficulty do you have?
    4
  • Drag the slider to indicate the number that best describes your pain where: 0 = no difficulty and 10 = so difficult it requires help.*
    Washing your hair?00 - 00
    Washing your back?00 - 00
    Putting on an undershirt or jumper?00 - 00
    Putting on a shirt that buttons down the front?00 - 00
    Putting on your pants?00 - 00
    Placing an object on a high shelf?00 - 00
    Carrying a heavy object of 4.5 kilograms?00 - 00
    Removing something from your back pocket?00 - 00
    5
  • 6