Precautions
- Protect the repair: no resisted elbow flexion or forearm supination until ~6 weeks.
- No sudden, eccentric, or heavy loading until cleared.
- Fixation is typically a cortical button, which allows early active motion; progression is guided by comfort and swelling.
Phase 1 · Weeks 0–2 (Protect & Activate)
- Sling for comfort; no formal immobilization required with cortical-button fixation.
- Light functional use only — nothing heavier than a coffee cup. Max lift: a pencil.
- Begin gentle active and active-assisted elbow and forearm range of motion as tolerated.
- Gripping, wrist/finger and shoulder ROM (maintain uninvolved joints); control swelling.
Phase 2 · Weeks 2–6 (Restore Motion)
- Goal: full active and passive elbow flexion/extension and forearm rotation.
- Continue no resisted flexion or supination; wean from the sling.
- Light functional use of the arm.
Phase 3 · Weeks 6–12 (Strengthen)
- Begin progressive resisted strengthening of elbow flexion and supination.
- Graded lifting limits: 5 lb at 6 weeks, 10 lb at 8 weeks, 15 lb at 10 weeks, 25 lb at 12 weeks.
- Advance to unrestricted general lifting by ~12 weeks.
Return to Full Activity (~3–4 Months, Criterion-Based)
- Near-symmetric, pain-free elbow flexion and supination strength.
- Return to heavy manual labor, impact, and maximal eccentric loading at ~3–4 months.
References
- Rehabilitation Protocol for Distal Biceps Tendon Repair. Massachusetts General Hospital.
- Anatomic Distal Biceps Tendon Repair With All-Suture Cortical Buttons. Arthroscopy Techniques / PMC.
Modernized to current practice: cortical-button fixation supports early active motion; the lifting ladder was regularized (the prior version listed two 6-week steps), a resisted flexion/supination precaution and a strengthening phase were added, and heavy/impact loading was deferred to ~3-4 months. Evidence: Mass General and MGH-affiliated distal-biceps rehab protocols; cortical-button repair literature.