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Rate your ability to do the following in the last week
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Open a tight new jar
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Do heavy household chores (e.g. wash walls)
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Carry a shopping bag or briefcase
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Wash your back
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Use a knife to cut food
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Recreational activities in which you take some force or impact through your arm, shoulder, or hand
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During the past week to what extent has your arm, shoulder, or hand problem interfered with your normal social activities?
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During the past week, were you limited in your work or regular activites?
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Please rate the severity of the following during the last week
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Arm, shoulder, or hand pain
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Tingling (pins & needles) in your arm, shoulder, or hand
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During the past week, how much difficulty have you had sleeping?
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