Physical Therapy Protocol for Patients Following Distal Biceps Reinsertion at the Elbow

General Guidelines:

  • The program is designed to allow early ROM but restrict resistive forces across the elbow until the soft tissue has adequately healed to the bone
  • The slow and graduated recovery of strength allows controlled tension on the repair leading to stronger tissue/bone interface
  • Once therapy begins, the patient is encouraged to get rid of the sling
  • Patients are counseled to avoid quick sudden movements, repetitive movements, reaching for any weight over a pound or two and avoiding any activity that requires force or power. Patients are discouraged from using arms (especially operated side) to get up from chair, bed, etc.
  • Driving is not recommended until such time as the patient can safely get both hands on the steering wheel and operate the vehicle safely.
  • Daily showers and hygiene is encouraged with the precautions already stated.

Phase I

Zero to two (0-2) weeks

  • Most important concern is pain control, protection and personal hygiene
  • Patients are instructed in proper showering, dressing and ADL
  • Patients shoulder sleep with splint and sling and not take any chances
  • Wrist and digits are mobilized and arm is kept elevated to avoid stiffness and minimize edema
  • Gentle grip strengthening by using a “squeezy ball” keeps muscle pump going to reduce dependent edema
  • Patients are seen at approximately 2 weeks for suture removal and wound check

Two to four (2-4) weeks

  • No significant changes are made except that the splint is removed and ROM is begun
  • Prescription is given for PT to start at 4 weeks after surgery

Phase II

  • Begins when patient meets and begins working with therapist (usually at 4 weeks post op) and lasts until normal activities are resumed
  • May begin driving as soon as safe and confident (usually determined by patient)
  • Therapy is 3 sessions a week for 4 weeks at a time
  • Patients are encouraged and instructed in daily home stretches to assist therapist in achieving functional ROM

Motion

  • Consists of AAROM with gentle passive assist by therapist to improve ROM and function (therapist manually guides patient through range of motion with slow steady stretching)
  • Goal is to achieve full elbow extension, flexion, supination and pronation.

Strengthening

  • Very simple therapy plan using light hand held weights in a progressive resistive program. This is to help strengthen the tissue bone interface with light loading but not compromising the repair by excessive loading.
  • May also do some forearm grip strengthening as before using a spring loaded device or “squeezy ball”
  • All exercises are in sets of ten, with a 10 second interval up to 3 completed sets. Weight can be adjusted as tolerated up to the limit recommended (see below). Exercises are for elbow flexors, elbo w extensors, forearm supinators, forearm pronators, wrist extensors, wrist flexors and grip.
    • Weight limits are as follows; nothing more than a pound or two from the time they start therapy (4 weeks post op) until 6th post op week.
    • From 6th week on they can progress by 5 lbs each week until they are back to normal weight and needs.

Functional Progression for sports/activities and return to work

The following table is a guideline. Some patients may not need to lift this much but
these weights are also a guide for return to sport and work. Restrictions if available will fall within these parameters. These weights describe maximums for elbow flexion. Forearm rotators and grip strength will be far less.

Week #|Weight
Weeks 4-6|< 5 lbs 6th Week|5 lbs 7th Week|10 lbs 8th Week|15 lbs 9th Week|20 lbs 10th Week|25 lbs 11th Week|30 lbs 12th Week|35 lbs 13th Week|40 lbs 14th Week|45 lbs 15th Week|50 lbs 16th Week|60 lbs [/table]



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