Shoulder Pain Assessment

Is the pain in one shoulder or both?

The pain is in my right shoulder.

The pain is in my left shoulder.

The pain is in both shoulders.

Please select an option before proceeding.

Does the pain worsen during specific movements, like lifting your arm?

Yes, the pain worsens when I lift my arm above shoulder level.

Yes, the pain worsens during specific movements, like reaching behind my back or overhead.

No, the pain does not change with movement.

Other

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Do you feel weakness in your shoulder or arm? (Yes/No)

Yes

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Is the pain sharp, aching, or throbbing?

The pain is sharp and intense, especially with sudden movements.

The pain is a dull, aching discomfort that is constant or intermittent.

The pain is throbbing and feels like it comes in waves.

Other

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Have you experienced a recent injury or fall?

Yes

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How long have you been experiencing this pain?

Less than a week

1-4 weeks

Over a month

Other

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How would you rate your pain on a scale of 1-10?

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Have you taken any medications or treatments for this pain?

Yes

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Is this pain the first time you’ve experienced it, or have you had similar pain before?

Yes, this is the first time I’m experiencing this type of pain.

No, I’ve had this type of pain before, but it went away after a while.

No, I’ve had similar pain before, and it has been recurring.

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Have you ever been involved in a road traffic accident (car, bike, or pedestrian)?

Yes, I’ve been in a road traffic accident before and sustained injuries.

Yes, but I did not experience significant injuries at the time.

No, I’ve never been in a road traffic accident.

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Have you ever had any fractures or dislocations in your body, particularly around the affected area?

Yes, I have had a fracture or dislocation in the area experiencing pain.

Yes, I’ve had a fracture or dislocation in another area of my body.

No, I’ve never had any fractures or dislocations.

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Have you undergone any surgeries in the past, especially related to the area experiencing pain?

Yes, I’ve had surgery in the affected area (e.g., hip, shoulder, back).

Yes, I’ve had surgeries elsewhere in my body but not in the affected area.

No, I have never had any surgeries.

Please select an option before proceeding.

Do you have any other medical conditions that might be related to the pain, such as arthritis, diabetes, or autoimmune disorders?

Yes, I have a medical condition (e.g., arthritis, diabetes, fibromyalgia) that may be related to the pain.

No, I don’t have any known medical conditions related to the pain.

I’m not sure, but I’ve been diagnosed with other health issues.

Please select an option before proceeding.

Personal Details

First Name

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Last Name

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Body Type

Age

Minor Name

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Shoulder Pain Assessment

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