Quick Dash Shoulder Questionnaire

  • Please rate your ability to do the following activities in the last week by choosing the appropriate response:

    1 - No difficulty
    2 - Mild difficulty
    3 - Moderate difficulty
    4 - Severe difficulty
    5 - Unable
  • Rating:

    1 - Not at all
    2 - Slightly
    3 - Moderately
    4 - Quite a bit
    5 - Extremely
  • Rating:

    1 - Not limited at all
    2 - Slightly limited
    3 - Moderately limited
    4 - Very limited
    5 - Unable
  • Please rate the severity of the following symptoms in the last week.

    1 - None
    2 - Mild
    3 - Moderate
    4 - Severe
    5 - Extreme
  • Rating:

    1 - No difficulty
    2 - Mild difficulty
    3 - Moderate difficulty
    4 - Severe difficulty
    5 - So much difficulty that I can't sleep
  • Work Module (Optional)

    1 - No difficulty
    2 - Mild difficulty
    3 - Moderate difficulty
    4 - Severe difficulty
    5 - Unable
  • Sports/Performing Arts Module (Optional)

    1 - No difficulty
    2 - Mild difficulty
    3 - Moderate difficulty
    4 - Severe difficulty
    5 - Unable