Upper Extremity (Elbow, Wrist, and Hand) Pain Index

Upper Extremity Pain and Disability Index

Elbow, Wrist, Hand
Name*

First NameLast Name
Date*

MonthDayYear
Date
Please answer the following questions to the best of your ability in regards to the pain in your elbow/wrist/hand condition.

Please rate your pain where 0 = no pain, and 10 = the worst pain imaginable.
How severe is your pain at its worst?*

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How severe is your pain when lying on the involved side?*

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How severe is your pain when reaching for something on a high shelf?*

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How severe is your pain when touching the back of your neck?*

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How severe is your pain when pushing with the involved arm?*

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How much difficulty to you have washing your hair?*

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How much difficulty to you have washing your back?*

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How much difficulty do you have putting on an undershirt or sweater?*

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How much difficulty do you have putting on a shirt that buttons up the front?*

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How much difficulty do you have putting on your pants?*

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How much difficulty do you have placing and object on a high shelf?*

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How much difficulty do you have carrying a heavy object of 10lbs (4.5kg)?*

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How much difficulty do you have removing something from your back pocket?*

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Should be Empty:

Upper Extremity Pain and Disability Index