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DISTAL BICEPS REPAIR REHABILITATION PROTOCOL BY TENDAYI MUTSOPOTSI

DISTAL BICEPS REPAIR REHABILITATION PROTOCOL BY TENDAYI MUTSOPOTSI

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The purpose of this protocol is to provide the physiotherapist with a guideline for the post- operative rehabilitation course of a patient that has undergone a distal biceps tendon repair. It is not intended to be a substitute for appropriate clinical decision-making regarding the progression of a patient’s post-operative course. The actual post surgical physiotherapy management must be based on the surgical approach, physical examination/findings, individual progress, and/or the presence of post-operative complications. If a physiotherapist requires assistance in the progression of a post-operative patient they should consult with Mr. Andrew Sankey (Shoulder Consultant) or Mr. Tendayi Mutsopotsi (Specialist Shoulder Therapist)
The purpose of this protocol is to provide the physiotherapist with a guideline for the post- operative rehabilitation course of a patient that has undergone a distal biceps tendon repair. It is not intended to be a substitute for appropriate clinical decision-making regarding the progression of a patient’s post-operative course. The actual post surgical physiotherapy management must be based on the surgical approach, physical examination/findings, individual progress, and/or the presence of post-operative complications. If a physiotherapist requires assistance in the progression of a post-operative patient they should consult with Mr. Andrew Sankey (Shoulder Consultant) or Mr. Tendayi Mutsopotsi (Specialist Shoulder Therapist)

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Published by: Physiotherapy Care Specialists on Nov 07, 2012
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12/04/2012

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                                                               DISTAL  BICEPS  REPAIR  PROTOCOL  
                                                                                                                               PHYSIOTHERAPY  LED  POST  OPERATIVE  SHOULDER  CLINIC    

COMPILED  BY:  TENDAYI  MUTSOPOTSI  BSc.  HPT  (Hons)  MSc.  ORTHO-­‐MED  MCSP  MSOM  
                                                   APPROVED  BY:  MR  ANDREW  SANKEY  ORTHOPAEDIC  CONSULTANT  SURGEON  

                                                         
Distal  Biceps  Repair  Rehabilitation  Protocol  2010      Tendai  Mutsopotsi  (Specialist  Shoulder  Physiotherapist)  

  Distal  Biceps  Repair  Rehabilitation  Protocol  

 

  The purpose of this protocol is to provide the physiotherapist with a guideline for the postoperative rehabilitation course of a patient that has undergone a distal biceps tendon repair. It is not intended to be a substitute for appropriate clinical decision-making regarding the progression of a patient’s post-operative course. The actual post surgical physiotherapy management must be based on the surgical approach, physical examination/findings, individual progress, and/or the presence of post-operative complications. If a physiotherapist requires assistance in the progression of a post-operative patient they should consult with Mr. Andrew Sankey (Shoulder Consultant) or Mr. Tendayi Mutsopotsi (Specialist Shoulder Therapist) Post surgery, the patient has an adjustable splint placed with the elbow at 90°. The patient returns to the post-operative shoulder clinic at 2weeks.

Phase I: 0-3 weeks
Goals
• Elbow ROM from 30° to 120° of flexion • Maintain minimal swelling and soft tissue healing • Must achieve full forearm supination/pronation in 90° flexion

Precautions (0-2 weeks) • Backslab must be worn • Rotate forearm freely no flexion or extension to end range • Avoid pronation in extension Testing
• Bilateral elbow and forearm ROM

Exercises
• Six times per day the patient should set his IROM hinged brace at 30° of extension and 120° of flexion and perform active assistive flexion and active extension exercises within the brace. Two sets of 10 are performed. The brace is then reset at 90°, the forearm straps are loosened, and the patient performs 2 sets of 10 forearm rotations. The straps should then be secured. • Ice after exercise, 3-5 times per day • A sling should be worn only as needed for comfort with the patient maintaining full shoulder ROM.
Distal  Biceps  Repair  Rehabilitation  Protocol  2010      Tendai  Mutsopotsi  (Specialist  Shoulder  Physiotherapist)  

Phase II: 3-6 Weeks
Goals
• • Full elbow and forearm ROM by 6 weeks Scar management

Testing
• Bilateral elbow and forearm ROM • Grip strengthening at 5-6 weeks

Exercises
3 weeks: • The extension limit in the brace is adjusted to 20°. Flexion remains at 120°, but patient may remove brace to allow full flexion 2 times per day. The brace stays on at all other times except when washing the arm. • Scar massage 3-4 times per day. 4 weeks: • Extension limit is changed to 10°. • Continue the same exercises. • Putty may be used 3 times per day for 10 minutes to improve grip strength. 5 weeks: • The extension limit is changed to 0o and exercises are continued in the brace. 6 weeks: • The brace is discontinued, unless needed for protection. • Passive elbow extension exercises are initiated if needed. • Light strengthening exercises are initiated with light tubing or 2-3 pound weights for elbow flexion, extension, forearm rotation and wrist flexion and extension. • Ice is continued after strengthening exercises.

Clinical Follow-up
• The   patient   is   seen   at   6   and   12   weeks,   then   only   as   needed   until   full   motion   is   achieved  and  to  monitor  the  patient's  strengthening  program.  

Distal  Biceps  Repair  Rehabilitation  Protocol  2010      Tendai  Mutsopotsi  (Specialist  Shoulder  Physiotherapist)  

Phase III: 6 -24 Weeks
Goals
• The   strengthening   program   is   gradually   increased   so   that   the   patient   is   using   lightweights  by  3  months.  It  may  be  as  long  as  6  months  before  a  patient  returns  to   heavy  work  weights.    

Testing
• Grip strengthening • Elbow ROM

Exercises
• Elbow ROM exercises are performed if ROM is not within normal limits • Strengthening exercises to wrist, elbow, forearm, and possibly shoulder depending                    on  sport  and/or  work  requirements  

Clinical Follow-up
• The patient is seen only as needed to monitor progress with strengthening program. Milestone  driven     These   are   milestone   driven   guidelines   designed   to   provide   an   equitable   rehabilitation   service  to  all  of  our  patients.  They  will  also  limit  unnecessary  visits  to  the  outpatient  clinic   here   at   Chelsea   &   Westminster   by   helping   the   patient   and   therapist   to   identify   when   specialist  review  is  required.       If  patients  are  progressing  satisfactorily  and  meeting  milestones,  there  is  no  need  for  them   to  attend  clinic  routinely.         Failure   to   progress   or   variations   from   the   norm   should   be   the   main   reason   for   clinic   attendance.   Both   patients   and   therapists   can   book   clinic   visits   by   contacting   the   numbers   given  further  on  in  this  document.     Clinic  follow-­‐up  schedule:  at  2,  6,  12  and  16-­‐24  weeks  (only  if  necessary)            
Distal  Biceps  Repair  Rehabilitation  Protocol  2010      Tendai  Mutsopotsi  (Specialist  Shoulder  Physiotherapist)  

          Failure  to  progress       If  a  patient  is  failing  to  progress,  then  consider  the  following:         Possible  problem   Pain  inhibition   Action   • Adequate  analgesia   • Keep  exercises  pain-­‐free   • Return  to  passive  ROM  if  necessary   until  pain  controlled   • Progressing  too  quickly  –  hold  back   • If   severe   night   pain/resting   pain   –   refer  to  Shoulder  Unit   Patient  exercising  too  vigorously   • Increase   or   reduce   physiotherapy/   Patient   not   doing   home   exercise   (HEP)   (max   2-­‐4x/day)   for   few   programme  (HEP)  regularly  enough   days/weeks  and  assess  difference   • Ensure   HEP   focuses   on   key   exercises  and  link  to  function   Returned  to  activities  too  soon   Decrease  activity  intensity   Cervical/thoracic  pain  referral   Assess  and  treat  accordingly   Unable  to  gain  strength   Passive  ROM  may  need  improving     Altered  neuropathodynamics   Assess  and  treat  accordingly   It  is  essential  you  contact  us  if  you  have  any  concerns:   Useful Contacts   Mr.  Andrew  Sankey    (Shoulder  Consultant  Surgeon)  0203  315  8545   Mr.  Tendayi  Mutsopotsi  (Specialist  Shoulder  Therapist)     02087468404   Mr.                          (Secretary)  02087468545                                            

Distal  Biceps  Repair  Rehabilitation  Protocol  2010      Tendai  Mutsopotsi  (Specialist  Shoulder  Physiotherapist)  

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