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International Journal of Scientific and Research Publications, Volume 3, Issue 2, February 2013 138
ISSN 2250-3153
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ANNEXURE
01 Assessment form
01).Demographic data
• Name;
• Age;
• Sex;
• Occupation;
• Handedness; left right
• Chief complaint;
Shoulder pain yes no
Numbness yes no
Difficulties in overhead activities
Yes
no
02).History
History of present illness; DM HT Arthritis
Other
History of past medicine; NSAIDs Analgesics
Other
Personal history; Married Unmarried
Socio-economical history (Monthly income)
Rs;10,000
03). Investigations
-X-ray image………………………………………………………………………..
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