Distal Biceps Tendon Repair Rehabilitation: Phased Protocol & Milestones

Typical Recovery Timeline (Open or Endoscopic Repair)

Phase	Timeframe	Key Interventions	Milestones
I: Protection	0–2 wks	Posterior splint 90° flexion / neutral rotation; NWB elbow; wrist/hand AROM; cryotherapy	Incision healed; edema controlled
II: Early Motion	2–6 wks	Hinged brace: unlock 30°→130° by wk 6; passive/active-assist ROM; isometrics; no resisted supination/elbow flexion	Full passive ROM; brace discontinued wk 6
III: Strengthening	6–12 wks	Progressive resisted flexion/supination; closed-chain; scapular stabilization; cardio (lower body)	Strength 70% contralateral; functional ADLs
IV: Advanced / Return to Sport	12–24 wks	Plyometrics, interval throwing, sport-specific drills; isokinetic testing	>90% strength, no pain/apprehension; surgeon clearance

Critical Precautions

• No active supination against resistance before 8–10 weeks (graft/fixation failure risk).
• Night splinting (extension) often continued 6–8 weeks.
• Monitor for heterotopic ossification (indomethacin prophylaxis sometimes used).
• Neurovascular checks (radial nerve, posterior interosseous).

Outcomes

• Rerupture rate: 2–5%.
• Most regain full function; residual supination weakness possible.
• Compliance with protocol is the strongest predictor of success.

Protocol variations exist (surgeon-specific, acute vs. chronic, graft augmentation). Always follow your operating surgeon’s prescription.