Home » Patient Info » Patient Forms » Oxford Shoulder Score (OSS) Oxford Shoulder Score (OSS) Date of completion Clinician's name (or ref) : Patient's name (or ref) : Patient's Date of Birth : Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Year 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 PROBLEMS WITH YOUR SHOULDER Answer every question by ticking the appropriate box. If you are unsure about how to answer a question, please give the best answer you can. 1. During the past 4 weeks... How would you describe the worst pain you had from your shoulder ? None Mild Moderate Severe Unbearable 2. During the past 4 weeks... Have you had any trouble dressing yourself because of your shoulder? No trouble at all A little bit of trouble Moderate trouble Extreme difficulty Impossible to do 3. During the past 4 weeks... Have you had any trouble getting in and out of a car or using public transport because of your shoulder? No trouble at all A little bit of trouble Moderate trouble Extreme difficulty Impossible to do 4. During the past 4 weeks... Have you been able to use a knife and fork - at the same time? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No, impossible 5. During the past 4 weeks... Could you do the household shopping on your own? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No, impossible 6. During the past 4 weeks... Could you carry a tray containing a plate of food across a room? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No, impossible 7. During the past 4 weeks... Could you brush/comb your hair with the affected arm? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No, impossible 8. During the past 4 weeks... How would you describe the pain you usually had from your shoulder? None Very Mild Mild Moderate Severe 9. During the past 4 weeks... Could you hang your clothes up in a wardrobe, using the affected arm? Yes,easily With little difficulty With moderate difficulty With great difficulty No,impossible 10. During the past 4 weeks... Have you been able to wash and dry yourself under both arms? Yes,easily With little difficulty With moderate difficulty With extreme difficulty No,impossible 11. During the past 4 weeks... How much has pain from your shoulder interfered with your usual work (including housework)? Not at all A little bit Moderately Greatly Totally 12. During the past 4 weeks... Have you been troubled by pain from your shoulder in bed at night? No nights Only 1 or 2 nights Some nights Most nights Every night To send this data to doctor please click submit
