Distal Biceps Repair Rehab

Postoperative Distal Biceps Tendon Repair Rehabilitation Protocol

PHASE I: 1-3 WEEKS

  • For the first post op week, the patient is in a posterior splint that is not to be removed. Beyond that point, the patient wears a sling for comfort and weans it after 3 weeks

Clinical Goals

  • Elbow ROM from 30 degrees of extension to 130 degrees of flexion
  • Maintain minimal swelling and soft tissue healing
  • Achieve full forearm supination and pronation
  • Bilateral elbow and forearm ROM Exercises
  • Patient should perform passive ROM exercises from 30 degrees of extension to 130 degrees of flexion 5-6 times per day for 25 repetitions.
  • Apply ice after exercise sessions.
  • A sling or “cuff and collar” may be used for the splint or hinged brace respectively. Shoulder ROM exercises are encouraged.

PHASE II: 3-6 WEEKS Clinical Goals

  • Full elbow and forearm ROM by 6 weeks.
  • Scar management.
  • Bilateral elbow and forearm ROM
  • Grip strengthening at 4-6 weeks

PHASE II: 3-6 WEEKS Exercises

  • Week 3
    • Active extension limit changed to 20 degrees. Passive flexion may be increases to full flexion as tolerated.
    • Scar massage 3-4 times per day.
    • Active wrist flexion/extension.
    • Active ROM of hand in neutral position.
    • Supination/pronation through pain-free range.
  • Week 4
    • Active extension limit changed to 10 degrees.
    • Continue same exercises.
    • Putty may be used 3 times per day to improve grip strength.
    • Ladder with arm supported by unaffected extremity.
    • Gentle pulley while limiting elbow extension to -10 degrees.
  • Week 5
    • Full active extension is permitted.
    • Supine scapula stabilization with no weight.
    • Alphabet door / clockwise / counterclockwise circles with ball.
  • Week 6
    • Passive elbow extension exercises may be started if needed.
    • Light strengthening exercises are started with light Theraband or 1-kg weights for elbow flexion, extension, forearm rotation and wrist flexion and extension.
    • Shoulder Theraband strengthening exercises are started.
    • Supine scapula stabilization with 1kg weight.
    • Ball toss / trampoline chest pass 1kg weight.
    • Ice afters trengthening exercises.

Week 12

  • Can start unrestricted strengthening as pain permits

CLINICAL FOLLOW-UP

Patients are usually seen at 1 week post op, then at 5-6 weeks post op. Final visits are usually at 12 weeks.