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Shoulder Rehabilitation Progress Tracker

Patient Self-Monitoring Chart for Shoulder Recovery

Orthopedics

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Template Content

Last updated: Mar 24, 2025

Instructions for Use

Rate your progress daily using the scales provided below. Share this chart with your healthcare provider during follow-up visits.

Pain Scale (0-10)

  • 0: No pain
  • 5: Moderate pain
  • 10: Severe pain

Daily Activities Progress Chart

Range of Motion (degrees)

Movement Week 1 Week 2 Week 3 Week 4
Forward Flexion
External Rotation
Internal Rotation

Functional Activities (✓ when achieved)

  • Reaching overhead
  • Washing opposite shoulder
  • Tucking in shirt
  • Sleeping on affected side
  • Carrying light objects

Exercise Compliance

Record daily exercises completed:

  • Pendulum exercises: ___ sets
  • Wall slides: ___ repetitions
  • Stretching exercises: ___ minutes

Recovery Milestones

  • Pain-free sleep
  • Return to daily activities
  • Full range of motion
  • Normal strength

Notes

Record any concerns or unusual symptoms here:

Bring this chart to all follow-up appointments

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