The Oxford Shoulder Instability Score, or OSIS, is a 12-item patient-reported outcome measure developed for people with shoulder instability, including dislocation and subluxation presentations. Each item is scored from 0 to 4, giving a total score from 0 to 48, where higher scores indicate better shoulder function and fewer instability-related problems. The OSIS can support monitoring and progress tracking, but it does not diagnose shoulder instability or clear someone for sport on its own.
Shoulder instability can affect reaching, dressing, lifting, sleep, gym training, contact sport, overhead sport, throwing, confidence and willingness to use the arm in vulnerable positions.
The Oxford Shoulder Instability Score, commonly called OSIS or OISS, is a patient-reported outcome measure designed specifically for shoulder instability.
It is commonly used for:
shoulder instability monitoring
recurrent shoulder dislocation
shoulder subluxation
apprehension or worry about instability
post-stabilisation surgery follow-up
non-surgical instability management
return-to-training monitoring
return-to-sport progress tracking
research and outcome reporting
Oxford University Innovation describes the OSIS as a short, 12-item, condition-specific patient-reported outcome measure developed and validated for surgical and non-surgical outcomes in people presenting with unidirectional or multidirectional shoulder instability.
Outcome measure: Oxford Shoulder Instability Score
Abbreviations: OSIS, OISS
Body region: Shoulder
Type: Patient-reported outcome measure
Number of items: 12
Item score: 0–4
Total score range: 0–48
Higher score means: Better shoulder function and fewer instability-related problems
Lower score means: Greater reported instability-related limitation
Best used for: Shoulder instability, dislocation, subluxation and stabilisation follow-up
Key limitation: OSIS does not diagnose shoulder instability or determine return-to-sport readiness on its own
The OSIS is a shoulder instability-specific questionnaire.
It was developed to measure outcomes in people with shoulder instability, including people with recurrent dislocation, subluxation or instability-related symptoms.
The OSIS includes 12 items with five response options each. The items capture instability-related concerns across:
dislocation or slipping episodes
pain
daily activities
dressing
lifting
sport or activity limitation
confidence
sleep or symptom impact
work or usual activity impact
A 2024 Springer reference entry describes the OSIS as a 12-item patient-reported measure covering shoulder dislocation or subluxation events, pain and function in one composite scale.
The OSIS is used because shoulder instability can affect more than strength or range of motion.
A client may have good shoulder motion and strength but still report:
fear that the shoulder will slip
apprehension in overhead or abducted positions
reduced confidence with contact sport
difficulty dressing
avoidance of throwing
worry with gym pressing
reduced confidence sleeping or rolling
fear during falls or sudden arm movements
The OSIS can help professionals:
establish a baseline
quantify self-reported shoulder instability impact
monitor change over time
track symptoms after dislocation or subluxation
monitor post-operative progress
support education and goal setting
combine self-reported findings with physical testing
improve progress reporting in Measurz
The OSIS should support assessment reasoning and monitoring. It should not be used as a stand-alone diagnostic, treatment or clearance tool.
The OSIS measures the client’s perceived shoulder instability-related symptoms, function and confidence.
It may provide insight into:
frequency of slipping or dislocation episodes
pain related to shoulder instability
difficulty with daily activities
difficulty with dressing
difficulty with lifting or carrying
sport or recreation limitation
worry about the shoulder
confidence using the arm
perceived impact on usual activity
It does not directly measure:
labral integrity
capsular laxity
bone loss
rotator cuff strength
scapular control
neurological status
tissue healing
readiness to return to contact sport
readiness to return to overhead sport
The OSIS may be useful for:
exercise professionals
rehabilitation practitioners
strength and conditioning coaches
sport and performance teams
workplace health professionals
allied health support teams
movement assessment professionals
students learning shoulder outcome measures
professionals using Measurz or MAT for structured progress tracking
It may be relevant for clients with:
recurrent shoulder dislocation
shoulder subluxation
traumatic shoulder instability
atraumatic shoulder instability
multidirectional instability
post-stabilisation surgery recovery
apprehension during overhead or sport tasks
reduced confidence with contact or collision sport
instability-related activity limitation
The OSIS is condition-specific, so it is more suitable for shoulder instability than broad shoulder pain measures when instability is the main concern.
Use the OSIS when you want to understand how shoulder instability affects symptoms, function and confidence.
It may be useful at:
initial assessment
onboarding
post-dislocation baseline
post-subluxation baseline
reassessment
post-operative milestones
return-to-gym planning
return-to-contact training planning
return-to-overhead sport planning
discharge or progress review
The OSIS is most useful when repeated over time using the same version and scoring method.
Use caution when:
shoulder instability is not the main problem
the client has general shoulder pain without instability symptoms
the client cannot complete the questionnaire independently
language or literacy affects responses
the wrong language version is used
multiple body regions are driving limitation
many items are missing
the score is being used as a diagnosis
the score is being used as a pass/fail return-to-sport decision
The OSIS should not be used to:
diagnose shoulder instability
confirm labral injury
confirm structural shoulder damage
determine bone loss
determine tissue healing
identify the exact cause of symptoms
clear someone for work, training or sport
replace physical assessment
replace professional judgement
Oxford Shoulder Instability Score questionnaire
OSIS scoring guide
Measurz recording workflow
Client-reported symptom notes
Baseline and retest dates
Optional related physical tests, such as:
shoulder range of motion
shoulder strength testing
apprehension-related testing where appropriate
relocation or instability-related tests where appropriate
scapular control observation
closed-chain upper limb testing
contact or overhead exposure notes
sport-specific confidence notes
pain score
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire helps us understand how your shoulder instability is affecting your symptoms, confidence and daily or sport activities. It does not diagnose the cause of instability on its own, but it helps us monitor change over time.”
The OSIS can be completed:
on paper
digitally
independently
verbally if assistance is needed
before a session
during reassessment
as part of a Measurz workflow
Ask the client to:
answer based on their affected shoulder
select right or left shoulder where the form requires it
choose one response per item
answer based on the recall period in each question
answer every item where possible
ask for clarification if they do not understand wording
complete the same version at each retest
The Oxford University Hospitals form includes different recall periods across items, including one question about slipping or dislocation episodes during the last 6 months and several questions about symptoms or function during the last 3 months.
Record whether the OSIS was completed:
independently
digitally
on paper
verbally
with assistance
This supports repeatability and helps interpret change over time.
If assistance is needed:
explain instructions without leading the answer
avoid telling the client which score to choose
avoid prompting the client toward a “better” or “worse” response
record that assistance was provided
use the same assistance approach at retest where possible
Do not guess missing responses.
For best practice:
encourage completion of all 12 items
record any missing item
avoid comparing scores if missing-item handling differs between sessions
record whether the score was calculated from a complete or incomplete form
interpret incomplete scores cautiously
The OSIS includes 12 items.
Each item is scored from:
0: worst response
4: best response
The total score is calculated by adding all 12 item scores.
Score range:
Minimum: 0
Maximum: 48
Scoring direction:
Higher score: better outcome / better reported shoulder function
Lower score: greater instability-related limitation
Oxford University Innovation scoring guidance states that each OSIS question should be scored 0 to 4, with 4 representing the best outcome, and that summed scores run from 0 to 48, with 48 being the best outcome.
Retest at meaningful points, such as:
baseline
after a rehabilitation block
after a subluxation or dislocation event
before return to gym loading
before return to contact training
before return to overhead sport
post-operative milestones
discharge or progress review
For consistency, record:
date
affected side
dominant side
recent instability events
current sport or training exposure
contact or overhead exposure
recent flare-ups
current confidence
current restrictions
any major changes in activity demands
The OSIS is a self-report questionnaire, so it does not create physical testing risk.
However, worsening responses may support further assessment where the client reports:
repeated slipping or dislocation episodes
increasing apprehension
worsening pain
major loss of confidence
increasing activity avoidance
reduced function despite training progress
new neurological symptoms
The OSIS produces a total score from 0 to 48.
Higher scores indicate better reported shoulder function and fewer instability-related problems.
Lower scores indicate greater reported instability-related symptoms or limitation.
0: greatest reported instability-related difficulty
48: best reported shoulder status on the questionnaire
A higher OSIS score may suggest:
fewer instability-related problems
better shoulder confidence
better daily function
less pain or worry
better tolerance of activity
fewer limitations with sport or usual tasks
A lower OSIS score may suggest:
more instability-related limitation
more worry about the shoulder slipping
more pain or functional restriction
reduced confidence
reduced sport or recreation tolerance
greater impact on daily activity
An OSIS score does not prove:
the diagnosis
labral injury
capsular laxity
bone loss
shoulder structural stability
tissue healing
readiness to return to sport
whether imaging is required
whether one intervention caused the change
Example wording:
“Your OSIS score suggests your shoulder instability is still affecting confidence and activity. This does not tell us exactly what structure is involved, but it helps us track how your symptoms and confidence change over time.”
For general fitness clients, OSIS may help show how instability affects:
gym pressing
overhead lifting
carrying
dressing
sleep
confidence using the arm
avoiding certain positions
Interpretation cautions:
recent instability episodes may strongly influence scores
pain from non-instability shoulder conditions may affect responses
physical capacity should still be assessed
For athletes, OSIS is especially useful when instability affects confidence and participation.
It may help monitor:
contact confidence
overhead confidence
throwing or serving tolerance
apprehension in sport positions
avoidance of specific drills
confidence after dislocation or subluxation
readiness discussions alongside objective testing
A high OSIS score should not be treated as return-to-sport clearance on its own.
For contact or collision sport clients, interpretation should consider:
tackling exposure
falling exposure
opponent contact
training contact progression
apprehension under fatigue
protective bracing or taping use
medical or surgical guidance where relevant
For overhead athletes, interpretation should consider:
throwing volume
serving volume
overhead velocity
end-range confidence
fatigue response
shoulder strength and control
sport-specific exposure
For post-operative clients, OSIS can help monitor perceived stability, function and confidence over time.
Interpretation should consider:
surgery type
healing stage
restrictions
rehabilitation phase
return-to-contact or overhead timeline
medical or surgical guidance
current sport exposure
For multidirectional or atraumatic instability, OSIS may help monitor perceived instability impact.
Interpretation should also consider:
symptom irritability
generalised laxity if relevant
strength and control
load tolerance
movement confidence
functional goals
Meaningful change helps determine whether an OSIS score change is likely to matter.
Key terms:
MCID / MIC: the smallest change that may be meaningful to clients or professionals, depending on method used
MDC: the amount of change likely needed to exceed measurement error
SEM: estimated measurement error around a score
Responsiveness: ability of the questionnaire to detect change over time
PASS: patient acceptable symptom state
A 2021 study reported that literature on MCID values for shoulder instability PROMs was limited and that no previous MCID had addressed OSIS. The study was designed to determine the MCID for OSIS after arthroscopic Bankart repair.
Because meaningful change values are context-specific, OSIS MCID values should be interpreted according to:
shoulder instability type
surgical versus non-surgical context
follow-up timeframe
baseline score
sport demands
scoring method
population studied
When interpreting OSIS change:
compare the total score with baseline
check whether the change exceeds available MCID or MDC values for a matching population
check whether instability episodes have reduced
compare with pain, confidence and sport exposure
consider strength, ROM and functional test findings
avoid over-interpreting very small changes
Reported meaningful change values may vary by:
traumatic versus atraumatic instability
unidirectional versus multidirectional instability
surgical versus non-surgical management
contact versus non-contact sport
time since dislocation or surgery
baseline score
follow-up timeframe
When no matching MCID, MDC or SEM value exists, interpretation should rely more heavily on:
baseline comparison
repeated measurement
client-reported change
activity exposure
instability event frequency
related physical assessment findings
professional judgement
Broad general-population normative values for OSIS are limited because the OSIS is a condition-specific shoulder instability questionnaire.
Evidence level: Level 3 — practical comparison guidance is recommended when exact norms are not available or not applicable.
Use:
baseline comparison
retest comparison
instability event history
sport exposure
confidence notes
pain and symptom response
related physical assessment findings
Practical guidance:
Scores closer to 48 generally suggest better shoulder status.
Lower scores suggest greater instability-related limitation.
Norms for healthy populations are not the main interpretation method.
Baseline and repeated measures are usually more useful than one isolated score.
Compare scores only when the same OSIS version and scoring method are used.
Avoid using one OSIS score as a return-to-sport threshold.
Comparison should consider:
age
sport
position or role
contact exposure
overhead exposure
dominant side involvement
instability type
surgery history
time since last instability event
training load
The OSIS was developed and validated as a shoulder instability-specific patient-reported outcome measure.
Oxford University Innovation states that the OSIS is practical, reliable, valid and sensitive to clinically important change.
An ISPOR presentation database summary of the original development and validation reported:
Cronbach’s alpha of 0.91 at pre-treatment assessment and 0.92 at follow-up
high test-retest correlation of r = 0.97
coefficient of reliability of 5.7
construct validity through correlation with Constant and Rowe clinical scores
responsiveness with a large standardised effect size of 0.8 or greater
The OSIS has also been translated and validated in other languages. For example, a 2020 Arabic validation paper describes OSIS as a 12-question instrument used in shoulder instability research and evaluated validity and reliability of the translated version.
Reliability and validity are stronger when:
the correct OSIS version is used
the correct language version is used
all 12 items are completed
the same scoring method is repeated
the affected side is clearly recorded
retesting occurs at meaningful time points
results are interpreted alongside physical and sport-specific assessment
Interpret cautiously when:
multiple items are missing
the client has general shoulder pain rather than instability
recent sport exposure has changed substantially
the client has not attempted feared activities
the score is used as a stand-alone diagnosis or clearance decision
the language version has limited validation evidence
Common errors include:
treating OSIS as a diagnosis
using OSIS as return-to-sport clearance
not recording affected side
not recording dominance
not recording recent instability events
ignoring sport or contact exposure
not recording completion method
ignoring missing items
over-interpreting small changes
failing to pair it with physical testing
Limitations include:
self-report can be influenced by recent instability episodes, pain or confidence
scores do not identify the exact structural cause of instability
broad normative values are limited
meaningful change values vary by population and treatment context
sport-specific readiness requires additional testing
high scores do not guarantee safety in contact or overhead sport
it should be paired with physical assessment, history and client goals
The OSIS may help professionals:
document baseline shoulder instability impact
monitor change after dislocation or subluxation
track perceived confidence and function
monitor post-operative stabilisation progress
support return-to-gym discussions
support return-to-sport planning
guide client education
improve communication with coaches or support teams
strengthen Measurz reports
For fitness clients, OSIS can show whether shoulder instability affects pressing, overhead lifting, carrying or confidence.
For athletes, OSIS can support broader return-to-sport reasoning but should be paired with sport-specific exposure and physical testing.
For post-surgical clients, OSIS can help monitor perceived stability and confidence across rehabilitation phases.
For Measurz users, OSIS is most useful when combined with practical measures such as:
shoulder range of motion
shoulder strength
apprehension-related findings
closed-chain upper limb tests
scapular control observations
pain score
instability event history
contact or overhead exposure
sport-specific confidence notes
Record:
outcome measure name: Oxford Shoulder Instability Score / OSIS / OISS
version used
date completed
completion method: paper, digital, interview or assisted
language/version used
condition or presentation being tracked
affected side: left, right or bilateral
dominant side
total score out of 48
score range: 0–48
direction of scoring: higher score indicates better outcome
missing items, if any
assistance provided, if any
recent dislocation or subluxation episodes
current pain score, if relevant
current symptoms
current confidence level
current gym, work or sport exposure
contact or overhead exposure, if relevant
key functional limitations
confidence or participation goals
baseline comparison
MCID/MDC comparison where supported
item-level activities that improved or worsened
related physical assessment findings
interpretation notes
retest date
referral or further assessment notes where appropriate
Record whether the main limitation appears to be:
instability episode frequency
apprehension or worry
pain dominant
dressing or daily activity limitation
lifting or carrying limitation
overhead activity limitation
contact sport limitation
return-to-sport confidence limitation
mixed instability-related limitation
unclear due to incomplete responses
This improves:
repeatability
communication
client education
assessment reasoning
monitoring over time
team consistency
reporting quality
The OSIS measures self-reported symptoms, function and confidence related to shoulder instability, including dislocation or subluxation problems.
The OSIS has 12 items.
Each item is scored from 0 to 4. The total score ranges from 0 to 48, with higher scores indicating better shoulder function and fewer instability-related problems.
Yes. Higher scores indicate better reported shoulder status.
No. OSIS measures the client’s reported instability-related symptoms and function. It does not diagnose shoulder instability or identify the structural cause.
Meaningful change values should be matched to the population and setting. A 2021 study specifically investigated OSIS MCID after arthroscopic Bankart repair because previous shoulder instability MCID evidence was limited.
Yes, it is useful for athletes with shoulder instability, but it should be paired with sport-specific testing, exposure tracking, strength, ROM, confidence and professional judgement.
No. OSIS can support return-to-sport reasoning, but it should not be used as the only clearance measure.
The Oxford Shoulder Instability Score is a 12-item shoulder instability outcome measure.
Each item is scored from 0 to 4.
Total scores range from 0 to 48.
Higher scores indicate better reported shoulder function.
OSIS is designed for shoulder instability, including dislocation and subluxation contexts.
OSIS does not diagnose instability or clear a client for sport.
Normative values are limited, so baseline and retest comparison are usually most useful.
Measurz should record version, total score, side, dominance, instability events, sport exposure, confidence, baseline comparison and related physical findings.
Dawson, J. (2023). Oxford Shoulder Instability Score. In F. Maggino (Ed.), Encyclopedia of Quality of Life and Well-Being Research (pp. 4916–4918). Springer. https://doi.org/10.1007/978-3-031-17299-1_2047
Oxford University Innovation. (2026). The Oxford Shoulder Instability Score (OSIS). https://innovation.ox.ac.uk/licence-details/oxford-shoulder-instability-score-osis
Oxford University Innovation. (n.d.). Scoring system for the Oxford Shoulder Instability Score. https://innovation.ox.ac.uk/wp-content/uploads/2014/09/OSIS_Scoring_System.pdf
Shaha, J. S., Cook, J. B., Song, D. J., Rowles, D. J., Bottoni, C. R., Shaha, S. H., & Tokish, J. M. (2021). Determining the minimal clinically important difference on the Oxford Shoulder Instability Score after arthroscopic Bankart repair. Orthopaedic Journal of Sports Medicine, 9(12), 23259671211060023. https://doi.org/10.1177/23259671211060023
Shahien, A., Azzam, W., Kamel, M., & El-Sayed, M. (2020). Validity and reliability of the Oxford Shoulder Instability Score questionnaire in Arabic. Journal of Musculoskeletal Disorders and Treatment, 6, 082.
Werthel, J. D., Sabatier, V., Schoch, B., et al. (2022). Patient-reported outcome measures for shoulder instability: A systematic review. Journal of Shoulder and Elbow Surgery.
