Protocol Guide. 2 days Post-op Light compressive dressing/garment for biceps area. Sling or hinged...

Distal Bicep RupturesProtocol Guide

Protocol Guide for Partial Biceps Muscle Tear

2 days Post-op Light compressive dressing/garment for biceps area. Sling or

hinged elbow brace at 90 degrees neutral forearm for comfort. Gentle unlimited A/AAROM hand to shoulder

HEP 10 min 3 times per day and wound care Clinic ROM program 3+ times per week and PRN wound

checks/care 10 days Post-op Continue HEP Clinic program BTE light (1 to 2 pounds) resistance AROM

hand to shoulder 3 times per week


10days Post-op Continue HEP Clinic program BTE light (1 to 2 pounds) resistance AROM

hand to shoulder 3 times per week

3wks Post-op Continue HEP UEB endurance exercises 3 times per week (At 3wks

muscle should be scared in satisfactorily) Wean from sling/brace wear by 4wks s/p


4 wks Post-op Continue HEP Baseline BTE power test sup/pro. BTE progressive strengthening

program 3 times per week (Ultimate Goal to have 70% sup/pro power of uninjured side)

6 wks Post-op Start 1 month HEP progressive pushup program

8 wks Post-op Transition to HEP progressive UE strengthening. Clinic follow up monthly BTE power test sup/pro until goal achieved.

May take up to 1yr.

12 wks Post-op Start progressive pullup/chinup program

Protocol Guide for Repair of Acute Distal Biceps Tendon Rupture

7 days Post-op Light compressive dressing/garment for biceps area.

Posterior long arm splint at 90 degrees neutral rotation. AROM extension and pronation. PROM flexion and supination

Flexion and extension in neutral rotation with 65 degree extension block

1 to 4 wks Post-op Progress to full AROM extension and pronation. Initially

flexion place-and-hold exercises. AROM flexion from 90 degrees


6 wks Post-op Wean from splint to 8wks 4 to 8 wks Post-op Progress to full AROM flexion

Continue with 9 wk Post-op guidance from Dynamic Hinged brace protocol


48 hours Post-op Light compressive dressing/garment for biceps area Posterior splint with elbow hinge locked at 90 degrees,

forearm in neutral for 3weeks AROM wrist and digits Codman’s pendulum exercises US, scar massage and edema control Clinic program 3+ times per week


3 wks Post-op Dynamic component (theratube/band) applied to the

posterior splint allowing resisted extension and passive flexion

From 3rd to 6th week progress to elbow extension 30 degree block

Gravity eliminated AROM out of splint in clinic with 30 degree extension block

Continue modalities Initiate AROM shoulder without resistance


6 to 9 wks Post-op Progress dynamic splint to 0 degrees extension (10 degree

increments per week) Initiate clinic exercise program with gravity focusing on

flexion and extension of elbow Continue modalities Continue flexion and extension of shoulder without resistance

9 wks Post-op Continue splint without extension block Initiate resistive exercises in clinic (shoulder, elbow and

forearm against gravity) Continue modalities as needed


12 wks Post-op Initiate progressive strengthening program elbow flexion

and forearm supination Continue modalities as needed

18 wks Post-op Cleared for full use Continue progressive strengthening program Ultimate Goals: AROM WNL compared to uninjured side100% preinjury strength. Full use in all activities (airborne

operations included) without pain

Distal Bicep RepairDySuFlex Protocol Guide

3 to 5 days post-op Light compressive dressing/garment for biceps area Scar massage, edema control

Fabricate DySuFlex splint. Elbow extension block at post-op resting position (typically 90 degrees). Clinic ROM program 10 min 3+ times per week and wound checks/care

Each week elbow extension is increased 15 degrees from

post op rest position

HEP 10 reps each hour within splint

Distal Bicep Repair DySuFlex Protocol Guide

6wks post-op Wean splint to discharge at 8 wks

Clinic AROM with gravity focusing on flexion and extension of elbow

Continue HEP

Continue with 9 wk Post-op guidance from Dynamic Hinged brace Protocol

Distal Bicep RepairDySuFlex Protocol Guide

Protocol Guide for Bicep short head, long head tendon and musculature repair

5days Post-op Light compressive dressing/garment for biceps area

Dynamic Elbow hinge splint extension blocked at 100 degrees, forearm in neutral. Dynamic component (theratube/band) allowing resisted extension and passive flexion, resting position of 120 degrees

Clinic and home program gentle ROM all without pain: AAROM shoulder

Splint exercises 10 reps per hour AROM extension from120 to 100 degrees, with rubber band traction PROM flexion resting at 120


5 days Post-op Continued PROM forearm supination to neutral with elbow at 100 AROM hand, wrist Sling wear for comfort over splint for night wear Splint wear all times except therapy exercises and wound

care 2 wks Post-op Codman’s pendulum exercises with splint on Ultrasound over wound area


3 wks Post-op Extension to 85 degrees. From 3rd to 6th week progress

dynamic splint extension block by 15 degrees extension of elbow each week

Continue modalities Initiate AROM shoulder without resistance

4 wks Post-op Initiate Elbow flexion place-and –hold exercises Extension to 70 Continue modalities


5 wks Post-op Initiate gravity eliminated AROM out of splint in clinic

respecting current extension block of that week Extension to 55 Continue modalities

6 wks Post-op Extension to 40 Initiate Gentle AROM supination and pronation with elbow

at 90 degrees. (Progress dynamic elbow splint by 10 degree increments per week)


6 wks Post-op (continued) Initiate clinic exercise program with gravity focusing on

flexion and extension of elbow Continue modalities Continue flexion and extension of shoulder without

resistance 10 wks Post-op Continue splint wear PRN for protection without extension

block. Initiate gentle resistive exercises in clinic (shoulder, elbow

and forearm against gravity) Continue modalities as needed


11 wks Post-op Discharge splint 12 wks Post-op Initiate progressive strengthening program elbow flexion and

forearm supination Continue modalities as needed

18 wks Post-op Cleared for full us Continue progressive strengthening program.

Ultimate Goals - AROM WNL compared to uninjured side,100% pre-injury strength. Full use in all activities without significant discomfort

Protocol Guide. 2 days Post-op Light compressive dressing/garment for biceps area. Sling or hinged...

Documents

Transcript of Protocol Guide. 2 days Post-op Light compressive dressing/garment for biceps area. Sling or hinged...