Upper Back Pain Assessment

Is the pain located between the shoulder blades or closer to the spine?

The pain is located between my shoulder blades.

The pain is closer to my spine.

The pain is spread across both areas, between the shoulder blades and near the spine.

Other

Please select an option before proceeding.

Does the pain increase with deep breathing? (Yes/No)

Yes

Please select an option before proceeding.

Is the pain accompanied by stiffness? (Yes/No)

Yes

Please select an option before proceeding.

Do you feel tightness in your chest or arms? (Yes/No)

Yes

Please select an option before proceeding.

Do you spend long hours sitting or at a desk?

Yes, I spend most of my day sitting at a desk for work or study.

Occasionally, I sit for extended periods but not every day.

No, I do not spend long hours sitting or at a desk regularly.

Please select an option before proceeding.

How long have you been experiencing this pain or issue?

Less than a week

1-4 weeks

Over a month

Other

How did the pain start?

Sudden

Gradual

Do you know the cause of pain?

Yes

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

Please select an option before proceeding.

Have you taken any medications or treatments for this pain?

Yes

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.

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.

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

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

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

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

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.

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.

Personal Details

First Name

Last Name

Body Type

Age

Minor Name

We will not share your personal information with anyone else or spam you.

Personal Details

Please enter email ID to receive report

Your report may password protected, please enter mobile number to receiver report password.

Please enter a valid contact number.

City

Terms and Conditions

I have read and agree to the GDPR Policy.

I have read and agree to the Privacy Policy and Terms of Service.

Form Submitted Successfully!

Your request has been sent. If you don’t receive a confirmation, please contact support.

Form Submission Failed!

An error occurred while submitting the form. Please try again.

Upper Back Pain Assessment

Personal Details

Personal Details

Terms and Conditions

Form Submitted Successfully!

Form Submission Failed!

Services

Useful Links

Info