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Rehab Exercises after Distal Biceps Tendon Rupture

Distal biceps tendon rupture is usually caused by a sudden and unexpected force on the biceps tendon when someone is trying to lift or catch heavy objects quickly. This injury mostly happened in men (95-98%), studies also found smoking is the most significant risk factor (7.5x).


⭐ Symptoms

* A popping sound and sudden severe pain in the elbow

Swelling and visible bruising around elbow and upper arm area.

* Significant weaknessElbow flexion strength decreases by 30% ~ 76.5% & supination (turning palm up) by 40% ~ 59.11%.

biceps tendon rupture


⭐ Treatments 

Since biceps tendon won’t heal back itself, surgery is mostly guaranteed in order to repair the tendon and regain arm strength. In some rare circumstances, the doctor may choose conservative intervention if patients have other medical conditions or higher risk of complication.

To learn more about the surgical repair for distal biceps tendon, please click here.


⭐ Rehab Exercises

* Post surgery 0-1 week: 

1. Elbow is resting within a cast or splint at 90° flexion, and forearm neutral.

2. Keep the arm elevated to prevent excessive swelling, you can refer to my edema management article.


* Post surgery 1-4 weeks:

1. A hinged elbow brace or long arm orthosis will be fitted for the elbow. Elbow extension is limited to 30°

2. Elbow passive flexion and active extension (lying on a bed, pic A&B)

3. Gravity eliminated elbow flexion/extension, you should rest your forearm on the table all the time. (I’ll recommend using a face cloth to decrease the friction on the table, which can make the elbow move more easily. (pic C)

4. Forearm pronation/supination (rotation, pic D)


* Post surgery 4-6 weeks:

1. Remove extension block, it’s safe to perform full active elbow extension as tolerated.

2. Continue gentle elbow exercises, the goal is to reach full elbow flex/ext range by week 6

3. Active assistive elbow exercises can be very helpful. (pic E)

4. Be careful when performing pronation (turning palm down) with elbow extension (“push stick away”), make sure you move your elbow slowly and painless.

* Post surgery 6-8 weeks:

1. Elbow brace or orthosis is no longer needed, no restriction in elbow active range of motion exercises. But still no heavy lifting or weight bearing

2. Start passive stretching for full elbow extension as tolerated. (Please note in pic F, the weight is for static stretching only, not for lifting exercises at all!)

* Post surgery 8-10 weeks:

Begin non-biceps strengthening (Grip and pinch strengthening)

* Post surgery 10-12 weeks:

Begin forearm and triceps strengthening. (pic G)

* Post surgery 3-6 months:

1. Begin progressive biceps strengthening. (pic H)

2. Gradually resume normal activities and return to weight bearing exercises.

⭐ Summary

In this article we shared the cause, symptoms and rehab protocol for distal biceps tendon rupture. However, every patient is unique, and different surgeon may prefer a totally different exercise protocol after the repair. In order to prevent elbow contracture, scar adhesion and muscle weakness, it’s super important to start elbow therapy as soon as 1 week after the surgery. Furthermore, thorough communication between the patient, surgeon and therapist is also essential to ensure the best outcome!


Andrew Tan, OTR/L, CHT, CKTP, CEAS
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Andrew Tan, OTR/L, CHT, CKTP, CEAS

The founder of "Rehab For A Better Life", specialized in ergonomic consultation, rehabilitation for upper extremity injuries, sports injuries and work-related injuries. Andrew believes rehab-related knowledge should be easy to learn and follow at home, because "knowledge is power only when we can share it" !