Rehabilitation following Biceps Tenodesis
Phase I (Week 0 – 4)
PROM: Passive Range of Motion
AROM: Active Range of Motion
Goals
Minimise pain and swelling
Regularly use ice therapy
Protect repaired biceps tendon
Keep wound areas clean and dry
Restore passive range of motion (PROM) of shoulder and elbow.
Promote adequate scapular function
Start weaning out of sling by the end of week 2 /3
Restrictions
No active range of motion (AROM) of the elbow or shoulder
Avoid shoulder external rotation beyond 40 degrees
Avoid resisted elbow flexion/forearm supination
No lifting, pulling, or pushing of objects with operated shoulder
No friction massage to the proximal biceps/tenodesis site.
Interventions
Wear your sling regularly including bedtime as directed by surgeon
Postural awareness
Ball squeezes
Scapular retractions and mobility exercises
PROM of elbow for flexion/extension, supination/pronation
AROM of elbow, neck and wrist
Shoulder PROM: avoid shoulder External Rotation - ER past 40 degrees and shoulder extension beyond neutral
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Phase II (Week 4 – 6)
PROM: Passive Range of Motion
AROM: Active Range of Motion
AAROM - Assisted Active Range of Motion
Goals
Aim for adequate pain control
Regularly use ice therapy
Commence gradual restoration of shoulder and elbow AROM
Progress shoulder motion from PROM to AAROM to AROM in all planes as pain allows
Begin light waist-level functional activities
Initial submaximal shoulder isometrics
Progress shoulder motion from PROM to AAROM to AROM in all planes as pain allows
Elbow flexion/extension AROM (no resistance)
Posterior capsular stretching as needed (cross body adduction stretch, side lying internal rotation stretch (sleeper stretch)
Restrictions
No lifting with affected upper extremity
No loading to biceps, elbow flexors, supinators
No friction massage to the proximal biceps tendon/tenodesis site
Avoid over stressing repaired tissue with stretching or manual therapy
Interventions
Progress to Shoulder AAROM - Assisted Active Range of Motion
Shoulder AROM - Active Range of Motion
Elbow AROM - flexion/extension
Forearm supination/pronation
Shoulder Isometrics
Posterior capsule stretching
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Phase III: From 6-8 weeks post-op to 10-12 weeks post-op
PROM: Passive Range of Motion
AROM: Active Range of Motion
ER - External Rotation
Goals
Normalize strength, endurance and neuromuscular control
Return to chest-level functional activities
Exercises should be pain-free and without compensatory patterns
Restrictions
No strengthening in specific plane until near full AROM achieved in that plane
No resisted biceps
Interventions
Patient can start gradually increasing shoulder activities
Shoulder AROM/PROM and stretching as needed to regain full ROM
Shoulder elevation in scapular plane (initially supine, progress to inclined, then upright)
Elbow flexion/extension with light resistance (progress as tolerated)
Forearm supination/pronation with light resistance (progress as tolerated)
Side lying shoulder External Rotation - ER
Prone shoulder extension, prone horizontal shoulder abduction
Standing shoulder ER and extension with theraband
Progress to shoulder IR on light pulleys or theraband
Biceps strengthening (elbow flexion, elbow supination)
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Phase IV
Goals
Return to full recreational activities
Return to full strenuous work activities
Continue stretching and strengthening exercises