Distal Biceps Repair

Lennard Funk 2007

Rehab protocol for repair of  Distal Biceps Rupture

Initial Immobilization

• Posterior backslab or hinged elbow brace, at 90 degrees for 2 weeks (with forearm in neutral) (Unless otherwise indicated by surgeon.)

Hinged Elbow Brace

• Elbow placed in a hinged brace at 5-7 days postoperative (if backslab was used at surgery). Brace locked at 90 degrees.
• Gradually increase elbow ROM in brace (see below)
• Brace may be removed by therapist for passive range of motion exercises below.
• Do not force or stretch! (ROM progression may be adjusted based on Surgeon's assessment of the surgical
  repair.)

Progress:

Weeks 0-2

• Passive ROM for elbow flexion and supination (full) 
• Pasive ROM for elbow extension and pronation (as tolerated, to limit of brace only)
• Sub-maximal pain free isometrics for triceps and shoulder musculature.
• Full Shoulder ROM exercises.
• Hand and wrist exercises

Week 2 - Lock brace at approx 60 degrees

Weeks 2-4 

• Continue passive ROM elbow flexion and extension, as tolerated - to limit of brace only.
• Sub-maximal pain free biceps isometrics with forearm in neutral
• Progress to Single plane active ROM elbow flexion, extension, supination, and pronation.  

Week 4 - Lock brace at approx 30 degrees

Weeks 4-6 

• Continue passive ROM elbow flexion and extension, as tolerated - to limit of brace only.
• Sub-maximal pain free biceps isometrics with forearm in neutral
• Single plane active ROM elbow flexion, extension, supination, and pronation. 

Week 6 - Discontinue brace if adequate motor control

Weeks 6-12

• Continue progression as above
• May begin combined/composite motions (i.e. extension with pronation).
• Progressive resisted exercise program is initiated for elbow flexion, extension, supination, and pronation.
• Passive stretching as required

12 Weeks +: Full Activity as tolerated is permitted. Return to sports.