Post-Operative Therapy Distal Biceps Tendon Repair

 

Note: This pathway is designed to serve as a guide to rehabilitation. Indications for progression should be based on patient’s complete operative procedure, functional capacity and response to treatment.

Post-Operative Elbow Immobilization

• Posterior splint with elbow immobilized at 90° for 1-2 weeks, which is not to be removed

Hinged Elbow Brace

• If no hinged brace was prescribed, limit extension and supination ROM to patient’s pain tolerance
• Elbow placed in hinged brace between 35° and 135°, but may vary at the discretion of the surgeon.
• Brace extension ROM is decreased to 20°, 10°, and 0° in weeks 3,4,5 respectively and worn for 7 weeks post-op.
• Only take the brace off for showering and exercise.

Phase 1 | Weeks 1 to 3

Goals by week 3:

• Elbow ROM 35-135°
• Full pronation and supination ROM
• Minimize swelling

Precautions:

• No active elbow flexion or lifting
• No aggressive elbow extension stretching, just passive extension ROM to patient tolerance
• No sudden and/or sharp movements

Therapeutic Exercise:

• Brace is removed to perform exercises
• PROM for elbow flexion and supination (with elbow at 90°) to patient tolerance
• AAROM for elbow extension and pronation (with elbow at 90°) to patient tolerance
• Shoulder, wrist and hand AROM, avoiding excessive shoulder extension
• Modalities to minimize inflammation and control pain

Phase 2 | Weeks 4 to 8

Goals by week 8:

• Full elbow and forearm AROM
• Scar management

Therapeutic Exercise:

• AAROM elbow flexion, progressing to AROM
• No aggressive elbow extension stretching
• Scar mobilization
• Grip strengthening
• Pulleys, UBE
• Progress to gentle strengthening at 6 weeks
• Shoulder/scapular stabilization
• Elbow joint mobilization

Phase 3 | After week 8

• If ROM restrictions persist, begin more aggressive stretching
• Progress strengthening gradually in all directions after week 8
• Return to mostly unrestricted activity at 4 months. Unrestricted intensity of biceps curls may resume between 4 and 6 months at surgeon’s discretion.