PatientIQ Patient Portal

Outstanding Tasks0

Complete Tasks Below
Click on the items below to complete.

ASES Test

Left ASES

Form

Left ASES
Form

Outstanding Tasks0

Complete Tasks Below
Click on the items below to complete.

ASES Test

Left ASES

Form

Left ASES
Form

ASES

Pain

Usual Work

Usual Sport/Leisure Activity

Do you have shoulder pain at night?

Yes

No

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Do you take pain killers such as paracetamol (acetaminophen), diclofenac, or ibuprofen?

Yes

No

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Do you take strong pain killers such as codeine, tramadol, or morphine?

Yes

No

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How many pills do you take on an average day?

Intensity of pain

Please click to use the slider below to indicate how bad your pain currently is.No pain at allPain as bad as it can be

Shoulder Instability

Please click to use the slider below to indicate how unstable your shoulder is.Very stableVery unstable

Activities of Daily Living

Is it difficult for you to put on a coat?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

Is it difficult for you to sleep on the affected side?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

Is it difficult for you to wash your back / do up bra?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

Is it difficult for you to manage toileting?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

Is it difficult for you to comb your hair?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

Is it difficult for you to reach a high shelf?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

Is it difficult for you to lift 10 lbs (4.5 kg) above your shoulder?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

Is it difficult for you to throw a ball overhand?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

Is it difficult for you to do your usual work?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

Is it difficult for you to do your usual sport/leisure activity?

Unable to do

Very difficult to do

Somewhat difficult

Not difficult

ASES Test

Left ASES

Left ASESForm

ASES Test

Left ASES

Left ASESForm

Pain

Activities of Daily Living

Left ASES
Form

Left ASES
Form