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Date of completion
Mayo Elbow Performance Score    
Clinician's name (or ref)
Patient's name (or ref)
 
Please answer the following questions.  
Section 1 - Pain Intensity
None
Mild
Moderate
Severe
   
Section 2 - Motion
Arc of motion greater than 100 degrees
Arc of motion between 50 and 100 degrees
Arc of motion less than 50 degrees
   
Section 3 - Stability
Stable
Moderate instability
Grossly Unstable
   
Section 4 - Function (Tick as many as able)
Can comb hair
Can eat
Can perform hygiene
Can don shirt
Can don shoe
The Mayo Elbow Score is

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Interpreting the Mayo Elbow Performance Score

Score greater than 90

Excellent

Score 75-89
Good
Score 60-74
Fair
Score below 60
Poor

References: Dawson,Jill; Fitzpatrick, Ray;Carr, Andrew;Murray,David. Questionnaire on the perceptions of patients about total hip replacement. British Journal of Bone and Joint Surgery. March 1996; 78-B(2): 185-190.