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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.

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