Rehabilitation after Distal Biceps Tendon Repair

Distal Biceps Tendon Repair or Reconstruction

Indications: 

• Acute (within 3 weeks) traumatic distal biceps rupture
• Chronic distal biceps tendon rupture

Protocol Acute Repairs (within 3 weeks of Injury)

Post Operation

Day 1 - 2 weeks

• Pain free active flexion and extension within limits of sling
• Full supination and pronation
• Full active shoulder movement with elbow flexion maintained

2 weeks

• Active ROM in all directions, to point of mild stretch. No overpressure.

6 weeks 

• Continue with Active ROM
• Introduce light resistance <2kg through full ROM
• Gradually increase resistance keeping progress pain free with easy and good quality movement

12 weeks

• Biceps strengthening

Protocol Chronic Injury Repairs

Day 1 - 2 weeks

• Pain free active flexion and extension within limits of sling
• Full supination and pronation
• Full active shoulder movement with elbow flexion maintained

2 weeks

• Active ROM in all directions, to point of mild stretch. No overpressure

12 weeks 

• Begin loading starting from <2kg and follow the above guideline as for acute repairs

** DO NOT USE THERABAND IN REHAB PROGRAM **

Milestones;

Acute Repairs

6 weeks 

• Full ROM flexion / extension / supination / pronation
• Pain free, Driving, Working

12 weeks 

• >90% strength in comparison to opposite side flexion/Supination

Warning:  Avoid sudden loading and unplanned movements for 6 weeks for both acute and chronic repairs

Chronic Repairs

6 weeks 

• Pain free 50-70% extension of ROM to other side
• Full ROM flexion / supination / pronation

12 weeks  

• <15 lag extension (80% of extension)
• Full ROM flexion / extension / supination / pronation, Pain free, Driving, Working

6 months 

• 80-90% Extension with full ROM in all other directions
• 80-90% flexion strength to contra-lateral side
• 70% supination strength to contra-lateral side

Warning:  Avoid sudden loading and unplanned movements for 6 weeks for both acute and chronic repairs

Return to functional activities

Return to work

• Sedentary job: as tolerated
• Manual job:     12 weeks

Driving

• 6 - 8 weeks

Swimming

• Breaststroke: 6 weeks 
• Freestyle: 12 weeks

Golf

• 12 weeks

Lifting

• Avoid lifting heavy items for 12 weeks.

Contact/High Impact Sports (e.g. Rugby League, AFL, martial arts, racket sports and Surfing)

• 12 weeks

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