Rehab Protocol: Distal Bicep Tendon Repair

First 2 weeks:

The bulky dressing (bandage and cotton wool) that was applied over the surgical dressing can be removed after 2-3 days, but leave the surgical dressing on. Keep the dressing dry.

The elbow is normally immobilized in a sling, but you can start moving the elbow as soon as pain allows. Support the forearm with your other hand and gently bend and straighten the elbow, without forcing anything. With the elbow flexed at 90 degrees, gently rotate your forearm to face palm up and palm down. You can progress to active elbow flexion (without supporting the arm) as soon as pain allows, but not against any resistance.

Perform regular hand and shoulder range of motion exercises. Occasionally, a backslab (splint) is applied after surgery, especially when surgery was delayed by more than a week. This will be kept on for 2 weeks. Your first follow-up appointment after surgery is at 2 weeks when a wound inspection will be done.

2 – 6 weeks:

Physiotherapy can be commenced. Keep the arm in a sling during this period but continue with a range of motion exercises, aiming to achieve full extension by 6 weeks.

In chronic cases where the biceps was repaired under tension, a different protocol may be followed. A hinged elbow brace may be chosen to limit extension initially and then gradually allow more extension every week. The second follow-up visit is at 6 weeks.

6 – 12 weeks:

The sling can be weaned at this stage. Continue stretching exercises if the full extension has not been achieved. Gradual strengthening is initiated at 6-8weeks, depending on the quality of the repair. Avoid heavy lifting and placing high loads on the biceps until 12 weeks.

You can start driving at about 6 weeks as long as you feel in control of the car. Another follow-up visit is scheduled at 3 months post-surgery.

After 12 weeks:

The physiotherapist will focus on further strength and endurance training. Rugby players can return to sport at about 4-6 months. Manual laborers will be able to return to normal duty at about 4-6 months.