Elbow Well Assessment

Welcome to the Elbow Wellness Assessment! This tool offers a quick and thorough evaluation of your Elbow health. By examining key aspects of functionality, strength, and mobility, you'll gain essential insights to help maintain and enhance your Elbow wellness. Start now to take the first step towards optimal Elbow health!

Score: 0 / 50 or 0%

Patient Identifier:

Date completed:

Section 1: Pain Intensity

I have no pain at the moment The pain is very mild at the moment The pain is moderate at the moment The pain is fairly severe at the moment The pain is very severe at the moment The pain is the worst imaginable at the moment

Section 2: Personal Care (Washing, Dressing, etc.)

I can look after myself normally without causing extra pain I can look after myself normally but it causes extra pain It is painful to look after myself but I am slow and careful I need some help but can manage most of my personal care I need help every day in most aspects of self care I do not get dressed, I wash with difficulty and stay in bed

Section 3: Lifting

I can lift heavy weights without extra pain I can lift heavy weights but it gives extra pain Pain prevents me from lifting heavy weights off the floor but I can manage if they are conveniently positioned (e.g. on a table) Pain prevents me from lifting heavy weights but I can manage light to medium weights if they are conveniently positioned I can lift very light weights I cannot lift or carry anything at all

Section 4: Function (Tick as many as able)

Can comb hair Can eat Can perform hygiene Can don shirt Can tie shoe Can feel severe pain

Section 5: Motion

Arc of motion greater than 120 degrees Arc of motion greater than 100 degrees Arc of motion greater than 80 degrees Arc of motion greater than 60 degrees Arc of motion greater than 30 degrees I avoid motion because it increases pain immediately

Section 6: Standing

I can stand as I like I can only stand as long as I like Pain prevents me from Standing more than 1 hour Pain prevents me from Standing more than 1/2 hour Pain prevents me from Standing more than 10 minutes I avoid Standing because it increases pain immediately

Section 7: Sleeping

I can sleep as I like I can only sleep as long as I like Pain prevents me from Sleeping more than 1 hour Pain prevents me from Sleeping more than 1/2 hour Pain prevents me from Sleeping more than 10 minutes I avoid Sleeping because it increases pain immediately

Section 8: Stairs

Normally without using a railing Normally using a railing In any manner Unable to do stairs Pain prevents me from doing I avoid because it increases pain immediately

Section 9: Social Life

I can involve as I like I can only involve as long as I like Pain prevents me from involving more peoples Pain prevents me from involving more peoples comfort Pain prevents me from involving more peoples Severe I avoid involving because it increases pain immediately

Section 10: Travelling

I can travel as I like I can only travel as long as I like Pain prevents me from Travelling more than 1 hour Pain prevents me from Travelling more than 2 day Pain prevents me from Travelling more than 10 days I avoid Travelling because it increases pain immediately

Progress Report

Elbow Score

Elbow Well Assessment

Patient Identifier:

Date completed:

Section 1: Pain Intensity

Section 2: Personal Care (Washing, Dressing, etc.)

Section 3: Lifting

Section 4: Function (Tick as many as able)

Section 5: Motion

Section 6: Standing

Section 7: Sleeping

Section 8: Stairs

Section 9: Social Life

Section 10: Travelling

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Elbow Score

Elbow Well Assessment

Patient Identifier:

Date completed:

Section 1: Pain Intensity

Section 2: Personal Care (Washing, Dressing, etc.)

Section 3: Lifting

Section 4: Function (Tick as many as able)

Section 5: Motion

Section 6: Standing

Section 7: Sleeping

Section 8: Stairs

Section 9: Social Life

Section 10: Travelling

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