Distal Biceps Tendon Repair Rehabilitation Protocol

PHASE I: (WEEK 0-3)

Splint/Brace

  • Post-op splint at all times for 1 week
  • Transition to hinged elbow brace locked at 90° after 1 week
  • Brace is unlocked only for ROM exercise (settings 30°-130°)

ROM/Therapeutic Exercise

  • Passive ROM exercises from 30°-130°, 5-6 times per day for 25 repetitions
  • Achieve full forearm supination and pronation
  • Shoulder, wrist, hand exercises encouraged
  • Edema control/Scar management
  • Apply ice after exercises

PHASE II: (WEEK 3-6)

Splint/Brace

  • Hinged elbow brace at all times except exercise or hygiene
  • Unlock brace according to ROM progression

ROM/Therapeutic Exercise

  • Week 3: Active extension limit changed to 20°. Passive flexion may be increased to full flexion as tolerated. 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°. Continue same exercises. Putty may be used 3 times per day to improve grip strength. Gentle pulley while limiting elbow extension to 10°.
  • Week 5: Full active extension is permitted. Supine scapula stabilization with no weight.
  • Week 6: Passive elbow extension exercises may be started as necessary. Light strengthening exercises started with light tubing or 1 kg weights for elbow flexion, extension, forearm rotation, and wrist flexion/extension. Shoulder theraband strengthening exercises started. Supine scapula stabilization with 1 kg weight.

PHASE III: (WEEK 6-6 MONTHS)

Splint/Brace

  • Discontinue at 6 weeks from surgery

ROM/Therapeutic Exercise

  • Gradual increase of strength program so that patient is using full weights at 3 months. Potentially up to 6 months before return to heavy work.
  • Continue ROM as necessary.

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