Page ContentBiceps Tenodesis ProtocolThis protocol has been modified and is being used with permission from the BWH Sports and Shoulder Service.The purpose of this protocol is to provide the clinician, therapist, and patient with a GUIDELINE of the postoperative rehabilitation course of a patient that has undergone a Biceps Tenodesis for biceps dysfunction.The procedure entails cutting the long head of the biceps and reattaching the tendon more distally along the humerus. Multiple techniques exist including screw, anchor, and soft tissue fixation. The procedure is used for chronic biceps dysfunction and detachment from its origin. Phase IPassive Range of Motion Phase (starts approximately post op weeks 1- 4)GoalsAlleviate shoulder pain and inflammatory responseAchieve gradual restoration of passive range of motion (PROM), limit full elbow extension immediatelyEnhance/ensure adequate scapular functionPrecautions/Patient EducationNO active range of motion (AROM) of the elbowNO excessive external rotation range of motion (ROM) / stretching. Stop when you feel the first end feel.Use of a sling to minimize activity of biceps x 3 weeksAce wrap upper forearm as needed for swelling controlNO lifting of objects with operative shoulderKeep incisions clean and dryNo friction massage to the proximal biceps tendon / tenodesis sitePatient education regarding limited use of upper extremity despite the potential lack of or minimal pain or other symptomsActivityShoulder pendulum hang exercisePROM elbow flexion/extension and forearm supination/pronationAROM wrist/handBegin shoulder PROM all planes to tolerance /do not force any painful motionScapular retraction and clock exercises for scapula mobility progressed to scapular isometric exercisesBall squeezesSleep with sling as needed supporting operative shoulder, place a towel under the elbow to prevent shoulder hyperextensionFrequent cryotherapy for pain and inflammationPatient education regarding postural awareness, joint protection, positioning, hygiene, etc.May return to computer based workMilestones to progress to phase IIAppropriate healing of the surgical incisionFull PROM of shoulder and elbowCompletion of phase I activities without pain or difficulty Phase IIActive Range of Motion Phase (starts approximately post op week 5-6) GoalsAchieve gradual restoration of AROMBegin light waist level functional activitiesWean out of sling by the end of the 2-3 postoperative weekReturn to light computer work PrecautionsNo lifting, pushing, pulling ActivityBegin gentle scar massage and use of scar pad for anterior axillary incisionProgress shoulder PROM to active assisted range of motion (AAROM) and AROM all planes to toleranceNO resistance exercises. Active elbow flexion/extension and forearm supination/pronationBegin incorporating posterior capsular stretching as indicated Phase IIIStrengthening Phase (starts approximately post op week 7-9)GoalsNormalize strength, endurance, neuromuscular controlReturn to chest level full functional activitiesPrecautionsDo not perform strengthening or functional activities in a given plane until the patient has near full ROM and strength in that plane of movementActivityContinue A/PROM of shoulder and elbow as needed/indicatedInitiate biceps curls with light resistance, progress as toleratedInitiate resisted supination/pronationBegin rhythmic stabilization drillExternal rotation (ER) / Internal Rotation (IR) in the scapular planeMilestones to progress to phase IVAppropriate rotator cuff and scapular muscular performance for chest level activitiesCompletion of phase III activities without pain or difficulty Phase IVAdvanced Strengthening Phase (starts approximately post op week 10)GoalsContinue stretching and PROM as needed/indicatedMaintain full non-painful AROMReturn to full strenuous work activitiesReturn to full recreational activitiesPrecautionsAvoid excessive anterior capsule stressWith weight lifting, avoid military press and wide grip bench press.