01. During the last six months, how many times has your shoulder slipped out of joint (or dislocated)? *

02. During the last three months, have you had any trouble (or worry) dressing because of your shoulder? *

03. During the last three months, how would you describe the worst pain you have had from your shoulder? *

04. During the last three months, how much has the problem with your shoulder interfered with your usual work (including school, college or housework)? *

05. During the last three months, have you avoided any activities due to worry about your shoulder feared that it might slip out of joint? *

06. During the last three months, has the problem with your shoulder prevented you from doing things that are important to you? *

07. During the last three months, how much has the problem with your shoulder interfered with your social life (including sexual activity if applicable)? *

08. During the last four weeks, how much has the problem with your shoulder interfered with your sporting activities or hobbies? *

09. During the last four weeks, how often has your shoulder been 'on your mind' & how often have you thought about it? *

10. During the last four weeks, how much has the problem with your shoulder interfered with your ability or willingness to lift heavy objects? *

11. During the last four weeks, how would you describe the pain which you usually had from your shoulder? *

12. During the last four weeks, have you avoided lying in certain positions, in bed at night, because of your shoulder? *