| Pain | Points |
| Intensity (max. 5 points)—VAS scale | |
| Minimum (0 - 1) | 0 |
| Mild (2 - 4) | 1 |
| Moderate (5 - 7) | 3 |
| Severe (8 - 10) | 5 |
| Frequency (max 5 points) | |
| Intermittent (once a month) | 0 |
| Sporadic (a few times every week) | 1 |
| Frequent (several days a week) | 3 |
| Constant (daily) | 5 |
| Duration (max. 5 points) | |
| Hours | 0 |
| Days | 1 |
| Weeks | 3 |
| Months/years | 5 |
| distribution (max 5 points) | |
| Located | 0 |
| radiating | 1 |
| Referred | 3 |
| Diffuse | 5 |
| Associated signs (max. 5 points) | |
| Alterations in limb alignment or limb dysmetria | 1 |
| Muscular atrophy | 1 |
| Joint deformity | 1 |
| Maintained antalgic posture | 1 |
| Neurovegetative involvement: vasomotor alterations (hyperthermia, vasodilation, acrocyanosis), sweating or trophic disorders of the skin and appendages. | 1 |
| Muscle Tone (max. 2 points) |
|
| Hypertonia | 1 |
| Normal | 0 |
| Hypotonia | 1 |
| Absent | 2 |
| Muscle strength (max 5 points) Modified scale of the MRC (Medical Research Council) |
|
| Absent: total paralysis. (Active muscle contraction is not detected) | 5 |
| Minimal: visible muscle contraction without movement. (Some muscle contraction can be seen or palpated, without movement) | 4 |
| Low: movement, gravity removed. (Can move in the absence of gravity) | 3 |