MSK
GENICULATE ARTERY EMBOLIZATION
Name
Patient number
The WOMAC score
SYMPTOMS
S1. Do you have swelling in your knee?
S2. Do you feel grinding, hear clicking or any other type of noise when your knee moves?
S3. Does your knee catch or hang up when moving?
S4. Can you straighten your knee fully?
S5. Can you bend your knee fully?
STIFFNESS
S6. How severe is your knee joint stiffness after first wakening in the morning?
S7. How severe is your knee stiffness after sitting, lying or resting later in the day?
PAIN
P1. How often do you experience knee pain?
P2. Twisting/pivoting on your knee
P3. Straightening knee fully
P4. Bending knee fully
P5. Walking on flat surface
P6. Going up or down stairs
P7. At night while in bed
P8. Sitting or lying
P9. Standing upright
FUNCTION
A1. Descending stairs
A2. Ascending stairs
A3. Rising from sitting
A4. Standing
A5. Bending to floor/pick up an object
A6. Walking on flat surface
A7. Getting in/out of car
A8. Going shopping
A9. Putting on socks/stockings
A10. Rising from bed
A11. Taking off socks/stockings
A12. Lying in bed (turning over, maintaining knee position)
A13. Getting in/out of bath
A14. Sitting
A15. Getting on/off toilet
A16. Heavy domestic duties (moving heavy boxes, scrubbing floors, etc)
A17. Light domestic duties (cooking, dusting, etc)
SCORE
Total
VAS
AREA
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