Biceps Tenodesis

Orthopedic & Sports Medicine Specialists (OSMS)

Weight-Bearing

Strict sling x4 wks Phase I; sling fully discontinued Phase II

Key Restrictions

No lifting >12 oz and no biceps tension (avoid long arm flexion, resisted supination/elbow flexion, ER past 40 deg, shoulder extension) x4 wks Phase I; no cross-frictional massage, no swimming/throwing/overhead serves Phase II-III; no swimming/throwing/overhead serves until wk 12

Timeline & Phases

Phase I (surgery-4 wks): cryotherapy 20 min q2h, full passive ROM for flexion/abduction/IR/ER, GH/scapulothoracic stabilizer activation, strict sling x4 wks, no lifting >12 oz, no biceps tension (avoid long arm flexion, resisted supination/elbow flexion, ER past 40 deg, shoulder extension) to protect tenodesis, grip strengthening, forearm/wrist ROM, cervical/scapular AROM, axillary nerve desensitization, elbow AAROM/PROM without resistance, AAROM/PROM for shoulder flexion/abduction/IR/ER, walking/Stairmaster/stationary bike with sling on; progress to Phase II with incisional healing, full shoulder PROM, full elbow ROM, negative impingement pain/apprehension; Phase II (4-6 wks): advance to AROM for flexion/abduction/IR/ER to neutral with normal scapulothoracic movement, begin proprioceptive/dynamic neuromuscular control training, strengthen shoulder/scap stabilizers, full sling discontinuation, no cross-frictional massage, no swimming/throwing/overhead serves, avoid fall-risk activities, gentle shoulder mobilizations as needed, AAROM/AROM all planes assessing scapular rhythm, RTC strengthening, ball squeezes, core strengthening, stationary bike without arms, impact exercises only once full RTC strength in neutral achieved; Phase III (6-12 wks): full shoulder/scapular ROM all planes, 5/5 RTC and peri-scapular strength, no swimming/throwing/overhead serves until wk12, avoid fall-risk activities, light isometrics with arm at side and scapular PREs at wk6, UE ergometer/weighted ball toss/body blade for eccentric resistance at wk8, demonstrate stability with higher-velocity/change-of-direction sport-specific movements, pain-free return to high-velocity overhead movements, improve core/hip strength/flexibility to offload shoulder, work capacity endurance training; return to throwing/swimming at 12 wks, throw from pitcher's mound at 18 wks, return to collision sports at 26 wks (MMI usually 26 wks)

Notes

OSMS Rehabilitation Guidelines; progressed quickly relative to other shoulder protocols to prevent stiffness (most common cause of failure); individual variation depends on surgeon input and concomitant rotator cuff findings; extensive references on biceps tendon rehabilitation and overhead throwing athlete protocols (Cools et al. 2007, Krupp et al. 2009, Nho et al. 2010, Reinold/Escamilla/Wilk 2009, Romeo et al. 2004, Ryu & Pedowitz 2010, Wilk et al. 2002/2011)