1. |
How often is your shoulder …: (always, daily, weekly monthly, never) |
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(a) Painful during activity? |
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(b) Painful when you sleep? |
2. |
What is the level of your shoulder pain: (very severe, severe, moderate, mild, none) |
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(a) When you are resting? |
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(b) With activities above your head? |
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(c) When you sleep? |
3. |
How ‘stiff’ is your shoulder? (very, quite, moderate, a little, not at all) |
4. |
How much difficulty do you have: (very severe, severe, moderate, mild, none) |
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(a) When reaching behind your back? |
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(b) With activities above your head? |
5. |
How is your shoulder overall? (very bad, bad, poor, fair, good) |