Distal Biceps Repair Rehabilitation Guidelines

Distal Biceps Repair Rehabilitation Guidelines

These guidelines outline the recovery process following a distal biceps tendon repair. Rehabilitation focuses on protecting the repair, restoring range of motion (ROM), and gradually regaining strength and functionality. A hinged elbow brace is used to control movement and support the repair during the early phases of recovery.

Surgical Overview

The biceps tendon is repaired by retrieving it from the upper arm and reattaching it to the radius bone using sutures and bone anchors. Post-surgery, a hinged elbow brace is applied, initially locking the elbow at 60–90 degrees of flexion.

Contraindications

1. Brace Use: Hinged elbow brace required for 6 weeks.
2. Activity Restrictions:
   • No active use of the operated arm for 3 weeks.
   • All daily activities (e.g., feeding, dressing) must be performed by the non-operated arm.

Rehabilitation Phases

Phase 1: 0–2 Weeks (Immediate Post-Surgery)

Goals:

• Manage swelling and pain using ice and elevation (if appropriate).
• Protect the repair with a Mayo hinged-elbow brace locked at 90°.
• Begin passive ROM for flexion (within brace limits) and full supination.
• Maintain mobility in adjacent joints: neck, scapulae, shoulder, wrist, and hand.

Precautions:

• Avoid forcing or stretching movements.

Key Interventions:

• Provide patient education on brace use and precautions.
• Refer to Physiotherapy Outpatients within 2 weeks.

Phase 2: 2–4 Weeks

Goals:

• Gradually increase passive ROM as tolerated, to the brace limit (60°).
• Initiate single-plane active ROM for flexion, extension, supination, and pronation.
• Begin sub-maximal isometrics:
  • Biceps (forearm neutral).
  • Triceps and shoulder muscles.

Precautions:

• Avoid overloading or forcing movements.

Phase 3: 4–6 Weeks

Goals:

• Further increase passive ROM as tolerated, to the brace limit (30°).
• Progress active ROM exercises in all planes.
• Continue sub-maximal isometrics for biceps, triceps, and shoulder muscles.
• Encourage light functional use of the arm and hand without lifting.

Key Interventions:

• Educate on safe use of the arm for daily activities.

Phase 4: 6–12 Weeks

Goals:

• Discontinue brace use by 6 weeks.
• Restore combined movements (e.g., flexion with supination).
• Gradually introduce and progress resisted exercises for flexion, extension, pronation, and supination.
• Begin passive stretching and light work/sport-specific activities.

Precautions:

• Avoid heavy lifting or overexertion during early strengthening.

Return to Activities

• Light duties: At 6 weeks.
• Heavy duties: At 12 weeks, including gradual return to sports as tolerated.

Contact Information

• Consultant Secretary: 07810 356433
• Sulis Hospital Physiotherapy: 01761 422388
• Circle Health Group Bath Clinic Physiotherapy: 01225 838767
• St. Joseph Physiotherapy: 01633 820321

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