Biceps Tenodesis

Physical Therapy Protocol

Phase I – Protective Phase (Weeks 0–3)

Goals:

• Protect surgical repair.
• Decrease pain and swelling.
• Full passive elbow flexion and extension.
• Allow 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 cleared by physician and once criteria below are met:
• Strength ≥90% of contralateral side.
• Full AROM.
• Completion of rebounder circuit.
• Clearance from physician.

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

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

Rebounder Circuit:

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

All exercises must be completed without residual pain or stiffness prior to beginning interval throwing.