Upper-limb symptoms can affect lifting, carrying, pushing, pulling, gripping, reaching, dressing, work tasks, sport, gym training and daily activities.
The DASH gives professionals a structured way to understand how the client perceives their upper-limb function and symptoms. It is designed to assess the whole upper limb rather than one isolated joint.
It may be useful for clients with symptoms involving the:
shoulder
elbow
wrist
hand
arm
upper-limb soft tissue or joint region
work-related upper-limb activity
sport or training-related upper-limb activity
The DASH should support assessment reasoning and monitoring. It should not be used as a stand-alone diagnostic or decision-making tool.
Outcome measure: Disabilities of the Arm, Shoulder and Hand
Abbreviation: DASH
Body region: Upper limb
Type: Client-reported outcome measure
Main questionnaire: 30 items
Optional modules: Work module and sports/performing arts module
Score range: 0–100
Higher score means: Greater upper-limb disability or symptom impact
Lower score means: Less upper-limb disability or symptom impact
Best used for: Upper-limb symptom and function monitoring
Key limitation: DASH does not identify the specific cause or tissue source of symptoms
The DASH is a 30-item questionnaire that asks the client about upper-limb symptoms and difficulty with daily activities.
It includes items related to:
physical function
daily activities
social activity
work or household tasks
pain
tingling
weakness
stiffness
sleep difficulty
confidence or perceived capability
The main DASH score is transformed to a 0–100 scale.
A lower score indicates better upper-limb status. A higher score indicates greater disability or symptom impact.
The DASH is used because upper-limb problems often affect more than pain intensity.
A client may report:
difficulty lifting objects
reduced grip tolerance
difficulty reaching overhead
pain during work tasks
trouble with dressing or washing
reduced training participation
disturbed sleep
reduced confidence using the arm
The DASH may help professionals:
establish a baseline
monitor change over time
understand perceived upper-limb function
track daily activity impact
compare self-reported function with physical test results
support goal-setting conversations
improve outcome reporting
The score should be interpreted alongside symptoms, goals, strength, range of motion, grip testing, work demands, sport demands and professional judgement.
The DASH measures self-reported upper-limb symptoms and function.
It may provide insight into:
daily activity difficulty
upper-limb pain
tingling or sensory symptoms
weakness
stiffness
sleep disruption
work or household limitation
social participation limitation
upper-limb confidence
change over time
It does not directly measure:
diagnosis
tissue damage
imaging findings
nerve function with certainty
muscle strength
joint range of motion
grip force
sport readiness
work readiness
surgical need
The DASH may be useful for:
exercise professionals
rehabilitation practitioners
strength and conditioning coaches
performance coaches
allied health support teams
movement assessment professionals
students learning outcome measures
professionals tracking upper-limb function
It may be relevant for clients with:
shoulder pain
elbow symptoms
wrist or hand symptoms
upper-limb overuse symptoms
post-injury upper-limb monitoring needs
post-surgical upper-limb monitoring needs
work-related upper-limb limitations
sport or gym-related upper-limb limitations
mixed upper-limb presentations
Use the DASH when you want to understand how upper-limb symptoms affect daily function and participation.
It may be useful at:
initial assessment
baseline measurement
reassessment
progress review
return-to-work planning
return-to-training planning
post-injury monitoring
post-surgical monitoring
discharge or follow-up review
The DASH is especially useful when symptoms affect multiple upper-limb activities or more than one upper-limb region.
Use caution when:
the client cannot complete the questionnaire independently
the wrong language version is used
many items are missing
symptoms are mostly from another body region
the client’s main goal is highly sport-specific and the optional module is not used
the score is interpreted without physical assessment context
the score is being used as a diagnosis or clearance tool
The DASH should not be used to:
diagnose a shoulder, elbow, wrist or hand condition
identify tissue damage
confirm nerve involvement
determine healing
explain symptoms on its own
clear someone for sport
clear someone for work
replace physical assessment
replace professional judgement
You need:
DASH questionnaire
official scoring instructions or validated calculator
baseline and retest dates
client-reported symptom notes
Optional related measures may include:
pain rating
grip strength
pinch strength
shoulder range of motion
wrist or hand range of motion
strength testing
task-specific function notes
work or sport exposure notes
Explain the purpose of the questionnaire before the client completes it.
Example wording:
“This questionnaire helps us understand how your arm, shoulder or hand symptoms are affecting daily activities. It does not diagnose the cause of symptoms, but it helps us monitor change over time.”
The DASH can be completed:
on paper
digitally
independently
verbally if assistance is required
before a session
during reassessment
as part of a progress review
Ask the client to:
answer based on the timeframe in the questionnaire
choose the response that best matches their experience
answer every item where possible
avoid overthinking each question
ask for clarification if they do not understand an item
complete the same version at retest
Record whether the DASH was completed:
independently
digitally
on paper
verbally
with assistance
This supports repeatability and interpretation.
Do not guess missing responses.
Use the official scoring guidance for the version being used. The main DASH score should not be calculated if too many items are missing.
The DASH main score is transformed to a 0–100 scale.
General scoring direction:
0: no disability
100: most severe disability
Higher scores indicate greater upper-limb disability or symptom impact.
Optional work and sports/performing arts modules are scored separately and should not be merged into the main DASH score.
Retest at meaningful time points, such as:
baseline
after a training or rehabilitation block
after return-to-work progression
after return-to-training progression
after symptom flare-up
progress review
discharge or follow-up
For consistency, record current activity exposure, work demands, training load, symptom flare-ups and whether the same version was used.
The DASH is a self-report questionnaire, so it does not create physical testing risk.
However, worsening scores, new neurological symptoms or major functional decline may support further assessment or referral where appropriate.
The DASH score ranges from 0 to 100.
Higher scores indicate greater upper-limb disability or symptom impact.
Lower scores indicate better upper-limb function and fewer symptoms.
A higher DASH score may suggest:
more upper-limb disability
greater pain or symptom impact
reduced ability to complete daily tasks
reduced work or household tolerance
reduced sport or training participation
sleep or confidence impact
broader participation limitation
A high score does not identify the exact diagnosis or tissue source.
A lower DASH score may suggest:
less upper-limb disability
fewer activity limitations
better perceived function
lower symptom impact
A low score does not exclude meaningful symptoms if they are highly task-specific or sport-specific.
A DASH score does not prove:
diagnosis
tissue damage
nerve involvement
imaging findings
strength capacity
joint range of motion
work capacity with certainty
sport readiness
whether one intervention caused the change
Example wording:
“Your DASH score gives us a structured view of how your upper-limb symptoms are affecting daily function. We will compare it with your baseline and combine it with your symptoms, goals, strength, range of motion and task-specific findings.”
For general fitness clients, the DASH may help show how upper-limb symptoms affect:
lifting
carrying
gym training
pushing or pulling
dressing
housework
daily tasks
For athletes, the DASH can help monitor upper-limb symptoms, but it may not capture all sport-specific demands.
The optional sports/performing arts module may be useful where relevant.
For work-related upper-limb symptoms, the DASH may help track how symptoms affect job tasks, household activity and confidence.
Interpretation should include actual work demands and exposure.
For older adults, DASH scores may be influenced by general health, arthritis-related symptoms, strength, balance, confidence, comorbidities and activity level.
For youth clients, consider reading level, comprehension and whether the measure is appropriate for the client’s age and activity context.
For persistent upper-limb symptoms, the DASH can help monitor broader impact over time, including confidence, sleep, work and participation.
Meaningful change helps determine whether a score change is likely to matter.
DASH meaningful-change values vary by population, condition, baseline severity and method.
Recent systematic review evidence has examined MCID values for both DASH and QuickDASH in musculoskeletal disorders, but no single value should be applied universally to every client or presentation.
In practical use, meaningful change should be interpreted with:
baseline comparison
repeated measurement
symptom change
task-specific function
work or sport exposure
client goals
related physical findings
professional judgement
Avoid over-interpreting small score changes, especially when activity exposure has changed between assessments.
DASH values vary by age, sex, work demands, sport demands, condition and cultural version.
Broad population comparisons may be less useful than the client’s own baseline.
Practical comparison guidance:
compare the client with their own baseline
use the same version at retest
interpret score change alongside activity exposure
consider work, sport or household demands
avoid using one score as a pass/fail threshold
use population-specific values only when they closely match the client
The DASH is widely used and has been translated and adapted across many languages.
Research supports its use as a region-specific measure of upper-limb disability and symptoms. Studies have examined its validity, reliability, responsiveness and cross-cultural measurement properties across different upper-limb conditions.
Reliability and validity are strongest when:
the correct version is used
the same version is repeated
scoring rules are followed correctly
missing items are handled appropriately
the client understands the questions
results are interpreted in an upper-limb relevant population
scores are compared with related physical and functional findings
Interpret cautiously when:
many items are missing
the client’s main limitation is outside the upper limb
symptoms are very task-specific
sport-specific demands are not captured
the score is used as a stand-alone decision
Common errors include:
treating DASH as a diagnosis
using the score as sport or work clearance
not using the official scoring method
ignoring missing items
merging optional module scores into the main score
comparing scores without considering activity exposure
over-interpreting small changes
ignoring strength, range of motion or task-specific findings
Limitations include:
self-report can be influenced by recent symptoms and activity
it does not identify the tissue source of symptoms
it does not measure strength, range or grip force directly
it may not capture every sport-specific demand
meaningful-change values vary by population
it should not replace physical assessment
The DASH may help professionals:
document baseline upper-limb status
monitor symptoms over time
track perceived function
support return-to-training discussions
support return-to-work reasoning
communicate progress clearly
compare self-reported function with physical testing
improve upper-limb outcome reporting
For athletes, use DASH alongside strength, range, task-specific testing and sport-specific exposure.
For workplace clients, interpret DASH alongside job demands, load exposure and task tolerance.
For persistent symptoms, DASH can help show whether upper-limb symptoms continue to affect confidence, sleep and participation.
The DASH measures upper-limb symptoms and difficulty with daily activities involving the arm, shoulder and hand.
The main DASH questionnaire has 30 items.
The main DASH score is transformed to a 0–100 scale. Higher scores indicate greater disability.
A lower score indicates better perceived upper-limb function and fewer symptoms.
No. DASH measures self-reported disability and symptoms but does not diagnose the cause.
No. QuickDASH is a shorter version. It is related but scored and interpreted as its own questionnaire.
It can support reasoning, but it should not be used as a stand-alone clearance tool.
It should be combined with symptoms, goals, strength, range of motion, task-specific testing and professional judgement.
DASH is a 30-item upper-limb outcome measure.
It assesses arm, shoulder and hand symptoms and function.
Scores range from 0 to 100.
Higher scores indicate greater upper-limb disability.
DASH does not diagnose a condition or identify tissue source.
Optional work and sport/performing arts modules are scored separately.
Interpretation is strongest when combined with symptoms, goals, physical testing and activity exposure.
Beaton, D. E., Katz, J. N., Fossel, A. H., Wright, J. G., Tarasuk, V., & Bombardier, C. (2001). Measuring the whole or the parts? Validity, reliability, and responsiveness of the Disabilities of the Arm, Shoulder and Hand outcome measure in different regions of the upper extremity. Journal of Hand Therapy, 14(2), 128–146. https://doi.org/10.1016/S0894-1130(01)80043-0
Gummesson, C., Atroshi, I., & Ekdahl, C. (2003). The disabilities of the arm, shoulder and hand outcome questionnaire: Longitudinal construct validity and measuring self-rated health change after surgery. BMC Musculoskeletal Disorders, 4, 11. https://doi.org/10.1186/1471-2474-4-11
Hudak, P. L., Amadio, P. C., Bombardier, C., & The Upper Extremity Collaborative Group. (1996). Development of an upper extremity outcome measure: The DASH. American Journal of Industrial Medicine, 29(6), 602–608. https://doi.org/10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L
Galardini, L., Coppari, A., Pellicciari, L., Ugolini, A., Piscitelli, D., La Porta, F., Bravini, E., & Vercelli, S. (2024). Minimal clinically important difference of the Disabilities of the Arm, Shoulder and Hand (DASH) and the shortened version of the DASH (QuickDASH) in people with musculoskeletal disorders: A systematic review and meta-analysis. Physical Therapy, 104(5), pzae033. https://doi.org/10.1093/ptj/pzae033
