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Date of completion
UCLA Shoulder rating scale    
Clinician's name (or ref) Patient's name (or ref)
 
Please answer the following questions.  
During the past 4 weeks......  
Section 1 - Pain   Section 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

 

    
Section 3 - Active forward flexion   Section 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  
The 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.

Reference for Score: Amstutz HC, Sew Hoy AL, Clarke IC. UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res. 1981 Mar-Apr;(155):7-20. Link to pubmed

Reference for Grading: Nutton RW , McBirnie JM , Phillips C. Treatment of chronic rotator-cuff impingement by arthroscopic subacromial decompression. J Bone Joint Surg Br. 1997 Jan;79(1):73-6.