1. Open a tight or new jar.
2. Do heavy household chores (e.g., wash walls, floors).
3. Carry a shopping bag or briefcase.
5. Use a knife to cut food.
6. Recreational activities in which you take some force or impact through your arm, shoulder or hand(e.g., golf, hammering, tennis, etc.).
7. 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?.
8. 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?.
Please rate the severity of the following symptoms in the last week.
9. Arm, shoulder or hand pain.
10. Tingling (pins and needles) in your arm, shoulder or hand.
11. During the past week, how much difficulty have you had sleeping because of the pain in your arm, shoulder or hand? (circle number)