Bicep Tenodesis

Accelerated rehabilitation is dependent on patient having intraoperative findings of good bone and tendon quality. Poor quality requires reverting to a traditional rehabilitation protocol

The patient may progress as tolerated as long as they do not experience pain during or immediately after exercising

Phase 1: Immediate postoperative period (weeks 0-1)

  • Goals
    • Maintain / protect the integrity of repair
    • Gradually increase AROM
    • Diminish pain and inflammation
    • Prevent muscular inhibition
    • Become independent with modified ADLs
  • Precautions
    • Maintain arm in sling for comfort. Can remove as tolerated for exercises
    • No sudden jerking motions
    • Keep incision clean and dry
  • Criteria for Progression to Phase 2
    • Active forward flexion to full
    • Active ER to full
    • Active IR to full
    • Active abduction to full in the scapular plane
  • Days 1 to 6
    • Sling for comfort
    • Pendulum exercises
    • Finger, wrist, and elbow AROM without weights
    • Begin scapula musculature isometrics / sets; cervical ROM
    • Cryotherapy for pain and inflammation
  • Days 3 to 6
    • Begin pulley exercises in forward flexion and abduction without restrictions
    • Maintain proper posture, joint protection, positioning and hygiene
  • Days 7 to 28
    • Continue with sling at night and day for comfort only
    • Pendulum / pulley exercises
    • Begin AROM to tolerance. No weight restrictions but must avoid rapid
      acceleration activities and / or loading of biceps
    • ER in scapular plane
    • IR in scapular plane
    • Continue elbow, wrist, and finger AROM / resisted
    • Maximal isometrics for all cuff, periscapular, and shoulder musculature
    • Cryotherapy is needed for pain control and inflammation
    • May resume general conditioning program (e.g., walking, stationary bike) Aquatherapy / pool therapy may begin one week postoperative

Phase 2: Protection and active motion (weeks 1-6)

  • Goals
    • Allow healing of soft tissue
    • Do not overstress healing tissue
    • Full AROM
    • Dynamic shoulder stability
    • Gradual restoration of shoulder strength, power, and endurance
    • Optimize neuromuscular control
    • Gradual return to functional activities
    • Decrease pain and inflammation
  • Precautions
    • No sudden jerking motions
  • Criteria for progression to Phase 3
    • Full AROM
  • Weeks 3-4
    • Discontinue sling
    • Gradually improve AROM
      • Flexion and elevation in the plane of the scapula
      • Abduction to full
      • External / Internal rotation to full
      • Extension to tolerance
    • Continue cryotherapy as needed
    • May use heat before ROM exercises
    • Aquatherapy OK for AROM exercises
    • Ice after exercise
  • Weeks 5-6
    • Continue AROM and stretching exercises
    • Continue rotator cuff isometrics
    • Continue periscapular exercises
    • Gradually progress AROM
      • Flexion, elevation in the plane of the scapula to full
      • External rotation to full
    • Internal rotation to full
    • Extension to tolerance

    Phase 3: Advanced strengthening (weeks 7-12)

    • Goals
      • Maintain full non-painful AROM
      • Advance conditioning exercises for enhanced functional use
      • Improve muscular strength, power and endurance
      • Gradual return to full activities
    • Week 7
      • Continue ROM and self-capsular stretching for ROM maintenance
      • Continue progression of strengthening
      • Advance proprioceptive, neuromuscular activities
      • Light sports (golf chipping / wedges, tennis ground strokes) if doing well
      • Continue strengthening and stretching
      • Continue stretching if motion is tight
      • Initiate interval sports program (e.g., golf, doubles tennis) if appropriate

    AAROM = active assisted range of motion
    ADL = activity of daily living
    AROM = active range of motion
    ER = external rotation
    IR = internal rotation
    PROM = passive range of motion
    ROM = range of motion