Please rate your ability to do the following activities in the last week.
*1. Open a tight or new jar.
*5. Push open a heavy door.
*6. Place an object on a shelf above your head.
*7. Do heavy household chores (e.g., wash walls, wash floors).
*8. Garden or do yard work.
*10. Carry a shopping bag or briefcase.
*11. Carry a heavy object (over 10 lbs.).
*12. Change a lightbulb overhead.
*13. Wash or blow dry your hair.
*15. Put on a pullover sweater.
*16. Use a knife to cut food.
*17. Recreational activities which require little effort (e.g., card playing, knitting, etc.).
*18. Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g., golf, hammering, tennis, etc.).
*19. Recreational activities in which you move your arm freely (e.g., playing frisbee, badminton, etc.).
*20. Manage transportation needs (getting from one place to another).
*22. During the past week, to what extent has your arm, shoulder or hand problem interfered with your normal social activities with family, friends, neighbors or groups?
*23. During the past week, were you limited in your work or other regular daily activities as a result of your arm, shoulder or hand problem?
*24. Arm, shoulder or hand pain.
*25. Arm, shoulder or hand pain when you performed any specific activity.
*26. Tingling (pins and needles) in your arm, shoulder or hand.
*27. Weakness in your arm, shoulder or hand.
*28. Stiffness in your arm, shoulder or hand.
*29. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand?
*30. I feel less capable, less confident or less useful because of my arm, shoulder or hand problem.