Date of completion
UCLA Shoulder rating scale    
Clinician's name (or ref)
Patient's name (or ref)
Patient's d.o.b
 
Please answer the following questions.  
During the past 4 weeks......  
1 - Pain   2 - Function
Present always and unbearable; strong medication frequently   Unable to use limb

Present always but bearable' strong medication occasionally

   Only light activities possible

None or little at rest' present during light activities; salicylates used frequently

  

Able to do light housework or most activities of daily living

Present during heavy or particular activities only; salicylates used occasionally

  

Most housework, shopping, and driving possible; able to do hair and to dress and undress, including fastening bra

Occasional and slight  

Slight restriction only; able to work above shoulder level
None   Normal activities

 

    
3 - Active forward flexion   4-Strength of forward flexion (manual muscle testing)
150°   Grade 5 (normal)
120°-150°    Grade 4 (good)
90°-120°   Grade 3 (fair)
45°-90°    Grade 2 (poor)
30°-45°   Grade 1 (muscle concentration)
<30°   Grade 0 (nothing)
     
Section5 - Satisfaction of patient  
UCLA Shoulder score is
Satisfied and better  
Not satisfied and worse  

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Interpreting the UCLA Shoulder rating scale
>27
 Good/Excellent
<27
 Fair/Poor
The maximum score is 35 points. Excellent / good indicates satisfactory results, where as fair / poor indicates unsatisfactory results.

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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.