Date of completion
Mayo Wrist Score    
Clinician's name (or ref)
Patient's name (or ref)
Patient's d.o.b
 
Please answer the following 12 multiple choice questions.  
During the past 4 weeks......  
1 - Pain Intensity   2 - Functional Status
No pain   Returned to regular employment
Mild Occasional   Restricted employment
Moderate, tolerable   Able to work, but unemployed
Severe to intolerable   Unable to work because of pain
     
3 (choose either 3a or 3b)
3a - Range of Motion (% of normal side)   3b - If only injured hand examined
100%    Greater than 120 degrees
75-99%    90-120 degrees
50-74%    60-90 degrees
25-49%    30-60 degrees
0-24%   less than 30 degrees
     
4 - Grip strength % of normal  
Mayo Wrist Score is
100%  
75-100%    
50-75%    
25-50%  

To save this data please print or

0-25%  
   

Interpreting the Wrist Mayo Score

90-100

Excellent
80-90
 Good
60-80
 Satisfactory
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.