Company Oxford Instability Score All fields are required. Your name * Your DOB * 1. During the last six months, how many times has your shoulder slipped out of joint (or dislocated)? * Not at all in 6 months 1 or 2 times in 6 months1 or 2 times per month1 or 2 times per weekMore often than 1 or 2 times/week 2.During the last three months, have you had any trouble (or worry) dressing because of your shoulder? * No trouble at allSlight trouble or worryModerate trouble or worryExtreme difficultyImpossible to do 3)During the last three months, how would you describe the worst pain you have had from your shoulder? * NoneMild acheModerate SevereUnbearable 4) During the last three months, how much has the problem with your shoulder interfered with your usual work (including school, college or housework)? * Not at all A little bit ModeratelyGreatlyTotally 5) During the last three months, have you avoided any activities due to worry about your shoulder feared that it might slip out of joint? * Not at all Very occasionally Some daysMost days or more than one activityEvery day or many activities 6) During the last three months, has the problem with your shoulder prevented you from doing things that are important to you? * No, not at allVery occasionallySome daysMost days or more than one activityEvery day or many activities 7. During the last three months, how much has the problem with your shoulder interfered with your social life (including sexual activity if applicable)? * Not at allOccasionallySome daysMost daysEvery day 8)During the last four weeks, how much has the problem with your shoulder interfered with your sporting activities or hobbies? * Not at allA little/occasionallySome of the timeMost of the timeAll of the time 9) During the last four weeks, how often has your shoulder been 'on your mind' & how often have you thought about it? * Never, or only if someone asksOccasionallySome daysMost daysEveryday 10) During the last four weeks, how much has the problem with your shoulder interfered with your ability or willingness to lift heavy objects? * Not at allOccasionallySome daysMost daysEveryday 11) During the last four weeks, how would you describe the pain which you usually had from your shoulder? * NoneVery MildMildModerateSevere 12) During the last four weeks, have you avoided lying in certain positions, in bed at night, because of your shoulder? * No nightsOnly 1 or 2 nightsSome nightsMost nightsEvery night Score Total:
