Distal Biceps Tendon Repair

• Initial recovery after shoulder surgery entails healing, controlling swelling and discomfort and regaining some elbow motion. The following instructions are intended as a guide to help you achieve these goals until your 1^stpostoperative visit.

• COMFORT
  • Cold Therapy
    • If you elected to receive the circulating cooling device, this can be used continuously for the first 3 days, (while the initial post-op dressing is on). After 3 days, the cooling device should be applied 3 times a day for 20-30 minute intervals.
    • If you elected to receive the gel wrap, this may be applied for 20 minutes on, 20 minutes off as needed. You may apply this over the post-op dressing. Once the dressing is removed, be sure to place a barrier (shirt, towel, cloth, etc.) between your skin and the gel wrap.
    • If you elected to use regular ice, this may be applied for 20 minutes on, 20 minutes off as needed. You may apply this over the post-op dressing. Once the dressing is removed, be sure to place a barrier (shirt, towel, cloth, etc.) between your skin and the gel wrap.
  • Medication
    • Pain Medication-Take medications as prescribed, but only as often as necessary. Avoid alcohol and driving if you are taking pain medication.
      • You have been provided a narcotic prescription postoperatively. Use this medication sparingly for moderate to severe pain.
      • You are allowed two (2) refills of your narcotic prescription if necessary.
      • When refilling pain medication, weaning down to a lower potency or non-narcotic prescription is recommended as soon as possible.
      • Extra strength Tylenol may be used for mild pain.
      • Over the counter anti-inflammatories (Ibuprofen, Aleve, Motrin, etc.) shoulder be avoided for the first 4 weeks following surgery.
    • Anti-coagulation medication: A medication to prevent post-operative blood clots has been prescribed (Aspirin, Lovenox, etc.) This is the only medication that MUST be taken as prescribed until directed to stop by Dr. Forsythe.
    • Nausea Medication – Zofran (Odansetron) has been prescribed for nausea. You may take this as needed per the prescription instructions.
    • Constipation Medication -Colace has been prescribed for constipation. Both your pain medication and the anesthesia can cause constipation. Take this as needed.
  • Driving – Driving is NOT permitted as long as the sling is necessary.

• ACTIVITIES
  • You are immobilized with a splint full time for the first week. Your doctor can tell you when you can discontinue use of the sling at your 1^stpostoperative visit. You will be fitted with a hinged elbow brace at this time.
  • Range-of-Motion Exercises – Your sling may be removed for gentle range-of-motion exercises for your shoulder and wrist only. This should be done 3x a day /15 repetitions.
    • Ball squeezes should be done in the sling (3x a day for 15 squeezes).
    • Physical therapy will begin approximately 1-2 weeks after surgery. Make an appointment with a therapist of your choice for this period of time. You have been given a prescription and instructions for therapy. Please take these with you to your first therapy visit.
    • Athletic activities such as throwing, lifting, swimming, bicycling, jogging, running, and stop-and-go sports should be avoided until cleared by Dr. Forsythe.

• WOUND CARE
  • Bathing - Tub bathing, swimming, and soaking of the elbow should be avoideduntil allowed by your doctor - Usually 2-3 weeks after your surgery. Keep the dressing on, clean and dry for the first 3 days after surgery.
    • You may shower 3 days after surgery. Keep your dressing clean, dry and intact. You may need to wrap your arm or sponge bathe to keep it dry.
  • Dressings – Remain in your splint until your 1^stpostoperative visit. You will be fitted with a removable brace at that time.

• EATING
  • Your first few meals, after surgery, should include light, easily digestible foods and plenty of liquids, since some people experience slight nausea as a temporary reaction to anesthesia

• CALL YOUR PHYSICIAN IF:
  • Pain in your elbow persists or worsens in the first few days after surgery.
  • Excessive redness or drainage of cloudy or bloody material from the wounds (Clear red tinted fluid and some mild drainage should be expected). Drainage of any kind 5 days after surgery should be reported to the doctor.
  • You have a temperature elevation greater than 101°
  • You have pain, swelling or redness in your arm or hand.
  • You have numbness or weakness in your arm or hand.

• RETURN TO THE OFFICE
  • Your first return to our office should be within the first 1-2 weeks after your surgery. Call your physician’s office to make an appointment for this first post-operative visit.

REHABILITATION PROGRAM:

Distal Biceps Tendon Repair

NOTE: The following instructions are intended for your physical therapist and should be brought to your first physical therapy visit.

• Distal Bicep Tendon Repair- Rehabilitation Protocol
  • The intent of this protocol is to provide the clinician with a guideline of the post-operative rehabilitation course for a patient that has undergone a distal biceps tendon repair. It is by no means intended to be a substitute for one’s clinical decision making regarding the progression of a patient’s post-operative course based on their physical exam/findings, individual progress, and/or the presence of post-operative complications. If a clinician requires assistance in the progression of a post-operative patient they should consult with the referring Surgeon.

• Initial Post operative Immobilization
  • Posterior splint, elbow immobilization at 90° for 5-7 days with forearm in neutral (Unless otherwise indicated by surgeon)
  • Hinged Elbow Brace
    • Elbow placed in a hinged ROM brace at 5-7 days postoperative.

• Phase I (0-3 weeks)
  • ROM: None
  • Immobilizer: Locked in neutral – worn at all times
  • Therapeutic Exercise: Gentle wrist and shoulder ROM

• Phase II (3-6 weeks)
  • ROM: Active extension to 30 degrees in brace
  • Immobilizer: Worn at all times (including exercise) – removed for hygiene
  • Therapeutic Exercise: Continue with wrist and shoulder ROM, begin active and extension to 30 degrees, NO active flexion, gentle joint mobilizations

• Phase III (6-9 weeks)
  • ROM: Active extension to 0 degrees in brace
  • Immobilizer: Worn at all times (including exercise) – removed for hygiene
  • Therapeutic Exercise: Continue to maintain wrist and shoulder flexibility, begin rotator cuff/deltoid isometrics, progressive active extension in brace
• Phase IV (9-12 weeks)
  • ROM: Gently advance ROM to tolerance
  • Immobilizer: None
  • Therapeutic Exercise: Begin active flexion and extension against gravity, advance strengthening in phase III to resistive, maintain flexibility/ROM

• Phase V (12 weeks -6 months)
  • ROM: Gradual return to full and pain free
  • Immobilizer: None
  • Therapeutic Exercise: Begin gentle flexion strengthening, advance activities in phase IV
• Phase VI (6 months and beyond)
  • ROM: Full and pain free
  • Immobilizer: None
  • Therapeutic Exercise: Return to full activity