Score the highest pain level you have experienced in your shoulder during ordinary activities within the last 24 hours.
B. Activities of daily living
1. Is your sleep disturbed by your shoulder?
Undisturbed sleep (2)
Occasional disturbance (1)
Every night (0)
How much of your normal daily work does your shoulder allow you to perform?
How much of your normal recreational activity does your shoulder allow you to perform?
To which level can you use your hand comfortably?
Below the waist (0)
Up to the waist (2)
Up to the sternum/xiphoid (4)
Up to the neck (6)
Up to the top of the head (8)
Above the head (10)
1. Forward flexion
2. Lateral elevation
3. External rotation (check all that apply).
Hand behind head elbow forward
Hand behind head elbow back
Hand on top of head elbow forward
Hand on top of head elbow back
4. Internal rotation (patient points to anatomical landmarks with thumb).
Strength of abduction (lbs).