DISTAL

BICEPS REPAIR PROTOCOL

PHYSIOTHERAPY LED POST OPERATIVE SHOULDER CLINIC

COMPILED BY: TENDAYI MUTSOPOTSI BSc. HPT (Hons) MSc. ORTHO-MED MCSP MSOM
APPROVED BY: MR ANDREW SANKEY ORTHOPAEDIC CONSULTANT SURGEON

Distal Biceps Repair Rehabilitation Protocol 2010 Tendai Mutsopotsi (Specialist Shoulder Physiotherapist)

 Distal Biceps Repair Rehabilitation Protocol

The purpose of this protocol is to provide the physiotherapist with a guideline for the postoperative rehabilitation course of a patient that has undergone a distal biceps tendon repair. It is not intended to be a substitute for appropriate clinical decision-making regarding the progression of a patients post-operative course. The actual post surgical physiotherapy management must be based on the surgical approach, physical examination/findings, individual progress, and/or the presence of post-operative complications. If a physiotherapist requires assistance in the progression of a post-operative patient they should consult with Mr. Andrew Sankey (Shoulder Consultant) or Mr. Tendayi Mutsopotsi (Specialist Shoulder Therapist) Post surgery, the patient has an adjustable splint placed with the elbow at 90. The patient returns to the post-operative shoulder clinic at 2weeks.

Phase I: 0-3 weeks

Goals
Elbow ROM from 30 to 120 of flexion Maintain minimal swelling and soft tissue healing Must achieve full forearm supination/pronation in 90 flexion

Precautions (0-2 weeks) Backslab must be worn Rotate forearm freely no flexion or extension to end range Avoid pronation in extension Testing
Bilateral elbow and forearm ROM

Exercises
Six times per day the patient should set his IROM hinged brace at 30 of extension and 120 of flexion and perform active assistive flexion and active extension exercises within the brace. Two sets of 10 are performed. The brace is then reset at 90, the forearm straps are loosened, and the patient performs 2 sets of 10 forearm rotations. The straps should then be secured. Ice after exercise, 3-5 times per day A sling should be worn only as needed for comfort with the patient maintaining full shoulder ROM.
Distal Biceps Repair Rehabilitation Protocol 2010 Tendai Mutsopotsi (Specialist Shoulder Physiotherapist)

Phase II: 3-6 Weeks

Goals
Full elbow and forearm ROM by 6 weeks Scar management

Testing
Bilateral elbow and forearm ROM Grip strengthening at 5-6 weeks

Exercises
3 weeks: The extension limit in the brace is adjusted to 20. Flexion remains at 120, but patient may remove brace to allow full flexion 2 times per day. The brace stays on at all other times except when washing the arm. Scar massage 3-4 times per day. 4 weeks: Extension limit is changed to 10. Continue the same exercises. Putty may be used 3 times per day for 10 minutes to improve grip strength. 5 weeks: The extension limit is changed to 0o and exercises are continued in the brace. 6 weeks: The brace is discontinued, unless needed for protection. Passive elbow extension exercises are initiated if needed. Light strengthening exercises are initiated with light tubing or 2-3 pound weights for elbow flexion, extension, forearm rotation and wrist flexion and extension. Ice is continued after strengthening exercises.

Clinical Follow-up
The patient is seen at 6 and 12 weeks, then only as needed until full motion is achieved and to monitor the patient's strengthening program.

Distal Biceps Repair Rehabilitation Protocol 2010 Tendai Mutsopotsi (Specialist Shoulder Physiotherapist)

Phase III: 6 -24 Weeks

Goals
The strengthening program is gradually increased so that the patient is using lightweights by 3 months. It may be as long as 6 months before a patient returns to heavy work weights.

Testing
Grip strengthening Elbow ROM

Exercises
Elbow ROM exercises are performed if ROM is not within normal limits Strengthening exercises to wrist, elbow, forearm, and possibly shoulder depending on sport and/or work requirements

Clinical Follow-up
The patient is seen only as needed to monitor progress with strengthening program. Milestone driven These are milestone driven guidelines designed to provide an equitable rehabilitation service to all of our patients. They will also limit unnecessary visits to the outpatient clinic here at Chelsea & Westminster by helping the patient and therapist to identify when specialist review is required. If patients are progressing satisfactorily and meeting milestones, there is no need for them to attend clinic routinely. Failure to progress or variations from the norm should be the main reason for clinic attendance. Both patients and therapists can book clinic visits by contacting the numbers given further on in this document. Clinic follow-up schedule: at 2, 6, 12 and 16-24 weeks (only if necessary)
Distal Biceps Repair Rehabilitation Protocol 2010 Tendai Mutsopotsi (Specialist Shoulder Physiotherapist)

 Failure to progress If a patient is failing to progress, then consider the following: Possible problem Pain inhibition Action Adequate analgesia Keep exercises pain-free Return to passive ROM if necessary until pain controlled Progressing too quickly hold back If severe night pain/resting pain refer to Shoulder Unit Patient exercising too vigorously Increase or reduce physiotherapy/ Patient not doing home exercise (HEP) (max 2-4x/day) for few programme (HEP) regularly enough days/weeks and assess difference Ensure HEP focuses on key exercises and link to function Returned to activities too soon Decrease activity intensity Cervical/thoracic pain referral Assess and treat accordingly Unable to gain strength Passive ROM may need improving Altered neuropathodynamics Assess and treat accordingly It is essential you contact us if you have any concerns: Useful Contacts Mr. Andrew Sankey (Shoulder Consultant Surgeon) 0203 315 8545 Mr. Tendayi Mutsopotsi (Specialist Shoulder Therapist) 02087468404 Mr. (Secretary) 02087468545

Distal Biceps Repair Rehabilitation Protocol 2010 Tendai Mutsopotsi (Specialist Shoulder Physiotherapist)