Distal Biceps Tendon Repair

Mammoth Orthopedic Institute / Sierra Park PT · Brian Gilmer MD (US Ski Team Physician); Karly Dawson PA-C

Weight-Bearing

N/A (elbow) — brace locked at 90 deg neutral forearm x2-3 days, then extend 10 deg every other day until full extension

Key Restrictions

Brace locked at 90 deg in neutral forearm x2-3 days; increase brace extension 10 deg every other day until full extension; brace worn at all times (removed for hygiene); PROM elbow from 45 deg at wk 2 progressing 10 deg/wk; no AROM biceps flexion x6 weeks; brace unlocked with AROM at wk 6; brace removed at wk 8; light biceps resistance training wks 8-12; avoid excessive shoulder extension Phase I; no UE sports until 6 months with MD clearance

Timeline & Phases

4 phases: Phase I (0-2 wks, brace locked then extending 10 deg every other day, wrist AROM, shoulder AROM, sub-max RC/triceps isometrics), Phase II (2-6 wks, PROM from 45 deg extending 10 deg/wk, no AROM biceps x6 wks, active triceps in brace, PROM supination/pronation at 90 deg flexion), Phase III (6-12 wks, brace unlocked AROM at wk 6, brace removed at wk 8, biceps isometrics wks 6-8, light progressive resistance wks 8-12, combined flexion/extension with supination/pronation), Phase IV (12-20 wks, full ADL return, gym weights at 12 wks, WB UE exercises, RTS at 6 months with MD clearance)

Notes

References Brigham and Women's Hospital; Gilmer MD version; nearly identical content to Crall version (elbow-distal-biceps-tendon-repair.pdf); Karly Dawson PA-C; no publication date listed; RTS for climbing/throwing sports at 6 months with MD clearance; brace extension protocol: 10 deg every other day; two Mammoth versions exist for this procedure (Crall and Gilmer) with same protocol content

Surgeon / Author

Brian Gilmer MD (US Ski Team Physician); Karly Dawson PA-C