Penn Shoulder Score
Visual Pain Scale
Total Pain Score : 30 / 30 = 100.00%
Visual Satisfaction Scale
Total Satisfaction Score : 10 / 10 = 100.00%
Visual Function Scale
Total Function Score : 60 / 60 = 100.00%
Part I: Pain & Satisfaction
Please circle the number closest to your level of pain or satisfaction
1. Pain at rest with your arm by your side:
No Pain - 0
Extreme Pain - 100
0
0
0
2. Pain with normal activities (eating, dressing, bathing):
No Pain - 0
Extreme Pain - 100
0
0
0
3. Pain with strenuous activities (reaching, lifting, pushing, pulling, throwing):
No Pain - 0
Extreme Pain - 100
0
0
0
4. How satisfied are you with the current level of function of your shoulder?
No Pain - 0
Extreme Pain - 100
0
0
0
Part II: Function
Please circle the number that best describes the level of difficulty you might have performing each activity
5. Reach the small of your back to tuck in your shirt with your hand.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
6. Wash the middle of your back/hook bra.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
7. Perform necessary toileting activities.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
8. Wash the back of opposite shoulder.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
9. Comb hair.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
10. Place hand behind head with elbow held straight out to the side
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
11. Dress self (including put on coat and pull shirt of overhead).
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
12. Sleep on affected side.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
13. Open a door with affected side.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
14. Carry a bag of groceries with affected arm.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
15. Carry a briefcase/small suitcase with affected arm.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
16. Place a soup can (1-2 lbs.) on a shelf at shoulder level without bending elbow.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
17. Place a one gallon container (8-10 lbs.) on a shelf at shoulder level without bending elbow.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
18. Reach a shelf above your head without bending your elbow.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
19. Place a soup can (1-2 lbs.) on a shelf overhead without bending your elbow.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
20. Place a one gallon container (8-10 lbs.) on a shelf overhead without bending your elbow
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
21. Perform usual sport/hobby.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
22. Perform household chores (cleaning, laundry, cooking).
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
23. Throw overhand/swim/overhead racquet sports.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
24. Work full-time at your regular job.
No difficulty (3)
Some difficulty (2)
Much difficulty (1)
Can't do at all (0)
Did not do before injury (No-Value)
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