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Distal Bicep Ruptures

Distal Bicep Ruptures. Protocol 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

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Distal Bicep Ruptures

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  1. Distal Bicep Ruptures Protocol Guide

  2. 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

  3. Protocol Guide for Partial Biceps Muscle Tear 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. Protocol Guide for Partial Biceps Muscle Tear 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

  5. 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. Protocol Guide for Repair of Acute Distal Biceps Tendon Rupture 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

  7. Protocol Guide for Repair of Acute Distal Biceps Tendon Rupture 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

  8. Protocol Guide for Repair of Acute Distal Biceps Tendon Rupture 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

  9. Protocol Guide for Repair of Acute Distal Biceps Tendon Rupture 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

  10. Protocol Guide for Repair of Acute Distal Biceps Tendon Rupture 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 side 100% preinjurystrength. Full use in all activities (airborne operations included) without pain

  11. Distal Bicep RepairDySuFlexProtocol 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

  12. Distal Bicep Repair DySuFlexProtocol 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

  13. Distal Bicep RepairDySuFlexProtocol Guide

  14. 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

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

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

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

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

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

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