Distal Biceps Repair — Bledsoe Brace Protocol

UW Health Orthopedic Surgery; UnityPoint Health - Meriter Rehabilitation · Dr. Zachary; Dr. Tofte; Dr. Kruse

Weight-Bearing

NWB surgical UE; posterior splint at 90° x 5–7 days; hinged Bledsoe brace with 50° extension block starting 7–10 days; 1–2 lb restriction early

Key Restrictions

No lifting/pushing/pulling >1–2 lbs involved UE phases I–IV; no WB involved UE; no strengthening until 8 wks for Dr. Kruse patients

Timeline & Phases

Phase I (7–10 days): posterior splint at 90° (forearm neutral) x 5–7 days; Bledsoe brace set 50° extension block to full flexion (brace locked ~60° between sessions); active elbow extension to 50°; active pronation (elbow supported/locked at 90°); passive elbow flexion; passive supination (elbow 90°); shoulder ROM (no aggressive extension); scar/wound/edema management; 1–2 lb restriction | Phase II (2–3 wks): progress extension block 10° per week (wk 2: 40°, wk 3: 30°); sub-maximal pain-free shoulder isometrics; light activities within restrictions; Dr. Kruse: NO strengthening until 8 wks | Phase III (4–5 wks): AROM/AAROM elbow flexion/extension (forearm neutral) and supination/pronation (elbow 90°); sub-maximal pain-free isometrics elbow flex/ext; brace wk 4: 20° block, wk 5: 10° block; Dr. Kruse: NO strengthening | Phase IV (6 wks): wean Bledsoe ~1 hr/day; combined/composite motions (e.g., extension with pronation); sub-maximal supination/pronation; brace wk 6: 0° extension to full flexion | Phase V (8 wks): D/C Bledsoe if adequate motor control and no pain; progressive resisted exercise (2–3 lbs max) elbow flex/ext/supination/pronation; if ROM deficits, consider static progressive orthosis after surgeon consultation; 5 lb restriction; Dr. Kruse: sub-maximal isometrics only at 8 wks | Phase VI (12–14 wks): full return to all activities; sport/work-specific strengthening; consider work hardening; WB as tolerated; Dr. Kruse: progressive resisted exercise (2–3 lbs max) beginning this phase

Notes

Bledsoe hinged brace protocol with progressive extension block (10°/week); surgeon-specific notes: Dr. Kruse delays strengthening to 8 wks and resisted exercise to 12–14 wks; Drs. Zachary and Tofte begin resisted exercise at 8 wks; swelling at elbow crease/scar normal for 6 months; developed collaboratively by UW Health and UnityPoint Health - Meriter Rehabilitation

Surgeon / Author

Dr. Zachary; Dr. Tofte; Dr. Kruse