Shoulder Assessment

"*" indicates required fields

Tell us about your shoulder pain, and we’ll give you a general idea what it means and what to do next.

When shoulder pain makes daily tasks harder or keeps you from the activities you enjoy, it’s time to get expert help—without needing a referral. This simple, ten-question assessment takes less than 5 minutes, and we’ll email you the results.

Pain

How severe is your pain? 0 = no pain and 10 = worst pain imaginable

At its worst*

When Sleeping (include not just pain but discomfort or inability to sleep)*

Reaching for something on a high shelf*

Touching the back of your neck*

Pushing with arm on the shoulder in question*

Functions of Daily Living

How much difficulty do you have? 0 = no difficulty and 10 = so difficult it requires help

Washing your hair or back*

Buttoning a shirt*

Putting on pants*

Placing an object on a high shelf*

Carrying a heavy object (10+ pounds)*

Have you ever been a patient at OrthoNebraska?*

Yes

What is Your Gender?*

Male

Female

Non-Binary or Other

Name*

First Name Last Name

Phone*

Email*

Submit your answers, and we'll email you the results. We'll also follow up with next steps and contact information to help you get closer to returning to the activities you love. OrthoNebraska pain assessments are not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. For a full diagnosis, schedule an appointment with one of our specialists, visit an OrthoNebraska Orthopedic Urgent Care or our emergency room. You understand that by completing this form, you are consenting to receive phone and email communications from OrthoNebraska, but you can opt-out at any time. Required field*

Agree

Tell us about your shoulder pain, and we’ll give you a general idea what it means and what to do next.

Pain

Functions of Daily Living

Locations

Get Directions

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