Surgical Orthopedic Associates Division
Curt D. Miller, M.D. Dean W. Trevlyn, M.D. Richard J. Levenberg, M.D. Mark P. Brigham, M.D.
Paul A. Horenstein, M.D. Anne E. Colton, M.D.
Broomall : 2004 Sproul Rd. 1st Floor Broomall, PA 19008 Phone (610) 353-0800 Fax (610) 359-1686
Roxborough: Jamestown Medical Bldg. 525 Jamestown Ave. Philadelphia, PA 19128 P(215) 482-6693 F(215) 482-2252
Physical Therapy Prescription
Patient Name:_____________________________________________________Date:_______________________
Diagnosis: Right / Left Acromioplasty with or without Distal Clavicle Resection & SLAP repair
Date of Surgery:______________________________________
4-1 skeeW
 PROM  AAROM  AROM as tolerated.
 EXCEPT: PROM ONLY in biceps flexion for 4 weeks to allow biceps to heal into humerus.
 EXCEPT: Elbow extension should be passive for 2 weeks then AAROM until 6 weeks.
 With a distal clavicle resection, hold cross-body adduction until 8 weeks post-op; otherwise, all else is
the same as without a distal clavicle resection.
 ROM goals: 90 degrees forward flexion and 20 degrees external rotation at side.
 No abduction-rotation until 4-8 weeks post-op.
 No resisted motions until 4 weeks post-op.
 D/C sling at 4 weeks post-op.
 Heat before/ice after PT sessions.
8-4 skeeW
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D/C sling totally, if not done previously.
Increase AROM in all directions with passive stretching at end ranges to maintain shoulder flexibility.
Goals: 140 degrees forward flexion and 40 degrees external rotation at side.
Begin light isometrics with arm at side for rotator cuff and deltoid; can advance to bands as tolerated.
Physical modalities per PT discretion.
21-8 skeeW
 Advance strengthening as tolerated: isometrics  bands  weights ; 10 reps/1 set per rotator cuff,
deltoid and scapular stabilizers.
 Only do strengthening 3x/week to avoid rotator cuff tendonitis.
 Increase AROM in all directions with passive stretching at end ranges to maintain shoulder flexibility,
goals advance to full.
 If ROM lacking, increase to full with passive stretching at end ranges.
 Begin eccentrically resisted motions, plyometrics, proprioception, and closed chain exercises (NO
Bodyblade!!).
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Frequency:________x/week for _______weeks
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Signature:_____________________________________________________________
Please fax a copy of patient report to (610) 359-1686 at least 3 days prior to patient follow up appointment.