Date of completion
Mayo Elbow Performance Score    
Clinician's name (or ref)
Patient's name (or ref)
Patient's d.o.b
 
Please answer the following questions.  
1 - Pain Intensity
None
Mild
Moderate
Severe
   
2 - Motion
Arc of motion greater than 100 degrees
Arc of motion between 50 and 100 degrees
Arc of motion less than 50 degrees
   
3 - Stability
Stable
Moderate instability
Grossly Unstable
   
4 - Function (Tick as many as able)
Can comb hair
Can eat
Can perform hygiene
Can don shirt
Can don shoe
Mayo Elbow Score is

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Interpreting the Mayo Elbow Performance Score
Score greater than 90

Excellent
Score 75-89
 Good
Score 60-74
 Fair
Score below 60
Poor

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Fritz JM, George S. Identifying Psychosocial Variables in Patients With Acute Work-Related Low Back Pain: The Importance of Fear-Avoidance Beliefs. Phys Ther. 2002; 82(10): 973-983.

Lethem J, Slade PD, Troup JDG, Bendey G. Outline of a fear avoidance model of exaggerated pain perceptions, Behav Res Ther. 1983;21:401-408.

Williamson E. Fear Avoidance Behavior Questionnaire. Austrailian Journal of Physiotherapy. 2006; 52: 149.

Vlaeyen JWS, Kole-Snijders AMJ, Boeren RGB, van Eck H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain. 1995;62: 36, 272.