QuickDASH
Name
*
First Name
Last Name
Please rate your ability to do the following activities in the last week by choosing the appropriate response below.
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Rows
No Difficulty
Mild Difficulty
Moderate Difficulty
Severe Difficulty
Unable
Opening a tight or new jar
Do heavy chores (e.g. wash walls, floors)
Carry a shopping bag or briefcase
Wash your back
Use a knife to cut food
Recreational activities in which you take some force or impact through your arm, shoulder or hand (e.g. golf, hammering, tennis, etc)
To what extent has your symptoms interfered with your normal social activities with family, friends, or neighbors?
How much are you limited in the work or other regular daily activities?
Arm, shoulder or hand pain
Tingling (pins and needles) in your arm, shoulder or hand
How much difficulty have you had sleeping because of the pain?
Subscore
Scoring Calculation
Scoring Calculation Continued
Final Score
Date
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Month
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Day
Year
Date
Signature
*
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