Distal Biceps Tendon Repair Rehab Protocol

Therapist reference

Physical Therapy Protocols · From Dr. Allred · Transcribed from the printed sheet · 6 sections

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If you have questions about a protocol or a specific patient, call the clinic where the surgery was performed.

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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.

Questions about this sheet? Call the clinic where the surgery was performed. I'm happy to talk through the plan. Numbers are at the top of this page, and every after-hours line is on the emergency numbers page.