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Cortisol Injection Questionnaire
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Have you had any adverse reactions to the injection which were not present when your last answered?
Have you had any adverse reactions to the injection which were not present when your last answered?
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Please score how your shoulder pain has been over the past 24 hours
Please score how your shoulder pain has been over the past 24 hours
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extremely painful
no pain at all
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Label (optional)
10
Label (optional)
Answer key
(0 points)
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How has your sleep been since the injection?
How has your sleep been since the injection?
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Time
can't sleep at all
very good
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Label (optional)
5
Label (optional)
Answer key
(0 points)
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How is your shoulder PAIN now, compared with before your shoulder injection?
How is your shoulder PAIN now, compared with before your shoulder injection?
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Date
Time
much worse
no problems at all now
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Label (optional)
5
Label (optional)
Answer key
(0 points)
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How is your shoulder MOVEMENT now, compared with before your shoulder injection?
How is your shoulder MOVEMENT now, compared with before your shoulder injection?
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Date
Time
much worse
perfect range of motion
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Label (optional)
5
Label (optional)
Answer key
(0 points)
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Overall, how pleased have you been with the result of your shoulder injection?
Overall, how pleased have you been with the result of your shoulder injection?
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Short answer
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Date
Time
Not pleased at all
Very pleased
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10
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Label (optional)
5
Label (optional)
Answer key
(0 points)
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