Biceps Tenodesis Rehabilitation Protocol

Phase I – Protective Phase (Weeks 0–3)

Goals:

• Protect surgical repair
• Decrease pain and swelling
• Full passive elbow flexion and extension
• Active elbow extension only

Precautions:

• No active elbow flexion for first 3 weeks
• No resisted elbow flexion or supination for first 6 weeks
• Wear sling or immobilizer at all times except for hygiene

Therapeutic Exercises:

• Gentle wrist and hand range of motion
• Shoulder pendulums and scapular retraction (starting immediately)
• Gentle passive elbow flexion and extension (starting POD 1)
• May initiate active elbow extension as tolerated

Criteria to Progress to Phase II:

• Controlled pain
• Full passive elbow range of motion
• Minimal muscle guarding

Phase II – Early Mobilization Phase (Weeks 3–6)

Goals:

• Begin gentle mobilization of the biceps tendon
• Improve shoulder and scapular mobility
• Develop muscle activation in shoulder stabilizers

Precautions:

• No resisted elbow flexion or supination until 6 weeks post-op
• Sling worn at all times (except hygiene/exercise); begin weaning at week 4

Therapeutic Exercises:

• Initiate shoulder passive and AAROM at week 3
• Gentle joint mobilizations as needed
• Scapular stabilization exercises
• Isometric shoulder and elbow exercises
• Begin active elbow flexion and supination at week 5

Criteria to Progress to Phase III:

• Tolerates prescribed shoulder/elbow AROM
• Minimal residual pain following activity

Phase III – Strengthening Phase (Weeks 6–9)

Goals:

• Reinforce proper scapulohumeral rhythm
• Begin progressive upper extremity strengthening
• Maintain full AROM

Therapeutic Exercises:

• Full AROM for elbow and shoulder
• Rotator cuff and deltoid strengthening (after 30 pain-free isometric reps)
• Isometric elbow flexion/extension
• Progress to resisted elbow flexion/extension as tolerated

Criteria to Progress to Phase IV:

• Shoulder strength at least 70% of contralateral side
• Good muscle contraction during isometric biceps strengthening
• Full, pain-free elbow and shoulder AROM

Phase IV – Advanced Strengthening Phase (Weeks 9–12)

Goals:

• Advance elbow and shoulder strengthening
• Initiate functional training

Therapeutic Exercises:

• Eccentric strengthening of the upper extremity
• Begin closed chain exercises
• Initiate two-arm plyometric drills

Criteria to Progress to Phase V:

• Strength at least 75% of contralateral side
• Tolerates increased activity without pain or swelling

Phase V – Return to Sport Phase (Weeks 12–24+)

Goals:

• Enhance muscle activation and function
• Resume advanced functional and sport-specific activity

Therapeutic Exercises:

• Eccentric elbow strengthening
• Push-up progression
• Single-arm plyometrics
• Sport-specific drills and functional training
• Begin interval throwing program when all criteria below are met:
  • Strength ≥90% of contralateral side
  • Full AROM
  • Completion of Rebounder Circuit (see below)
  • Clearance from physician

Criteria for Full Return to Sport (Approx. 5–6 Months):

• MD clearance
• Completion of interval throwing program
• Equal bilateral strength
• Passed sport-specific testing

Rebounder Circuit (Pre-Throwing Readiness Test)

Using a 1 lb medicine ball with the involved arm:

• Internal rotation toss at side: 2×30
• External rotation toss at side: 2×30
• Forward toss at 90/90 position (concentric): 2×30
• Backward toss at 90/90 position (eccentric): 1×30

Must complete all without residual pain or stiffness prior to initiating the throwing program.