Shoulder Pain Index

This questionnaire asks about your symptoms as well as your ability to perform certain activities.

Please answer every question, based on your condition in the last week, by selecting the appropriate number.

If you did not have the opportunity to perform an activity in the past week, please make your best estimate on which response would be the most accurate.

It doesn't matter which hand or arm you use to perform the activity; please answer based on your ability regardless of how you perform the task.

Please rate your ability to do the following activities in the last week by selecting the number for the appropriate response.

1 = No Difficulty

2 = Mild Difficulty

3 = Moderate Difficulty

4 = Severe Difficulty

5 = Unable to Peform Task

The following questions ask about the impact of your arm, shoulder, or hand problem on your ability to work, including homemaking if that is your main work role.

The following questions relate to the impact of your arm, shoulder, or hand problem on playing your musical instrument or sport or both.

If you play more than one sport or instrument (or play both), please answer with respect to that activity which is most important to you.

Shoulder pain is very closely related to the neck (cervical spine). This questionaire will give your provider information about how your neck condition affects your shoulder and everyday life. Please answer every section by marking the one statement that applies to you. If two or more statements in one section apply, please mark the one that most closely describes your pain.

I have no pain at the moment.The pain is very mild at the moment.The pain comes and goes and is moderate.The pain is fairly severe at the moment.The pain is very severe at the moment.The pain is the worst imaginable at the moment.

I have no trouble sleeping.My sleep is slightly disturbed (less than 1 hour).My sleep is mildly disturbed (1-2 hours).My sleep is moderately disturbed (2-3 hours).My sleep is greatly disturbed (3-5 hours).My sleep is completely disturbed (5-7 hours).

I can read as much as I want with no neck pain.I can read as much as I want with slight neck pain.I can read as much as I want with moderate neck pain.I cannot read as much as I want because of moderate neck pain.I can hardly read at all because of severe neck pain.I cannot read at all because of neck pain.

I can concentrate fully when I want with no difficulty.I can concentrate fully when I want with slight difficulty.I have a fair degree of difficulty concentrating when I want.I have a lot of difficulty concentrating when I want.I have a great deal of difficulty concentrating when I want.I cannot concentrate at all.

I can do as much work as I want.I can only do my usual but no more.I can only do most of my usual work but no more.I cannot do my usual work.I can hardly do any work at all.I cannot do any work at all.

I can look after myself normally without causing extra pain.I can look after myself normally but it causes extra pain.It is painful to look after myself and I am slow and careful.I need some help but I manage most of my my personal care.I need help everyday in most aspects of self care.I do not get dressed, I wash with difficulty and stay in bed.

I can lift heavy weights without extra painI can lift heavy weights but it causes extra painPain prevents me from lifting heavy weight off the floor, but I can manage if they are conveniently positioned (ex. on a table).Pain prevents me from lifting heavy weights from the floor, but I manage to lift medium weights if the are conveniently placed.I can only lift very light weights.I can not lift or carry anything at all.

I can drive my car without any neck painI can drive my care as long as I want with slight neck painI can drive my car as long as I want with moderate neck painI cannot drive my car as long as I want because of moderate neck painI can hardly drive my car at all because of severe neck painI cannot drive my car at all because of neck pain

I am able to engage in all my recreation activities without neck painI am able to engage in all my usual recreation activities with some neck painI am able to engage in most but not all of my usual recreation activities because of neck painI am only able to engage in a few of my usual recreation activities because of neck painI can hardly do any recreation activities because of neck painI cannot do any recreation activities at all because of neck pain

I have no headaches at allI have slight headaches which come infrequentlyI have moderate headaches which come infrequentlyI have moderate headaches which come frequentlyI have severe headaches which come frequentlyI have headaches almost all the time

DISABILITIES OF THE ARM, SHOULDER AND HAND (DASH)

Work Module

Sports/Performing Arts Module

Neck Index