Post-Operative Instructions: Distal Biceps Repair
Pain Medications
In most cases local or regional nerve blocks will provide 8-12 hours of numbness. As soon as you start to feel the numbness wearing off, begin taking oral pain medication.
Take Tylenol 500mg one tab every 8 hours.
Take Aleve (Naproxen) 220mg two tabs (440mg total) every 12 hours with food.
If you still have pain after Tylenol and Aleve/Naproxen, take one Norco tab (5mg/325mg).
If you still have pain after all of the above, take a second Norco tab.
Keep in mind Norco has Tylenol in it (325mg). If you take an extra Norco, then skip a dose of Tylenol.DO NOT exceed 3500mg of Tylenol over 24 hours.
It is illegal to drive or operate machinery with narcotic medications.
Do not combine alcohol or other sedatives with narcotic medications.
You do not need to take pain medications once you no longer have pain. You should stop the Norco first (usually 2-3 days), then wean off the others over the next week or two.
Other Medications
Take Zofran as needed for nausea (usually associated with anesthesia/narcotic meds).
Take an over-the-counter stool softener (Docusate/Senna/Miralax) as needed for constipation.
Activity
Wear your brace at all times for the first two weeks.
You may NOT bear any weight on or lift anything with your operative extremity.
Elevate your operative extremity above the heart as much as possible to decrease swelling.
Recovery Equipment
You should wear the elbow brace at all times day and night locked at 45°.
You may remove the brace for hygiene, but the arm needs to be supported and remain only at 45°.
Cold Therapy
We recommend cold therapy use as much as possible in the first two weeks.
Cold therapy units may be used continuously as instructed.
Ice packs should be applied 30 minutes at a time, with 30 minutes off between applications.
Do not apply ice directly to the skin to avoid burning.
Recovery Exercises
You may perform shoulder, wrist, and hand exercises as tolerated.
You will begin physical therapy around two weeks after surgery, after your first postoperative visit.
Diet: Please refer to your preoperative packet instructions.
Incision Care: Please refer to your preoperative packet instructions.
Emergencies: Please refer to your preoperative packet instructions.
Post-Operative Rehabilitation: Distal Biceps Repair
Therapy Plan: Twice per week for 0-2 months, once per week for 2-4 months
ROM Progression
Brace locked at 45° for 0-2 weeks.
Progress passive and active-assisted ROM as tolerated after 2 weeks with the goal of symmetric full motion at 8-10 weeks.
Strength Progression
Initially NO strengthening exercises for the biceps for 0-6 weeks after surgery.
Start isometric strengthening at 6 weeks
Progress strengthening against gravity starting at 9 weeks
Advance strengthening as tolerated after 12 weeks
Initial Post-Operative Physical Therapy Visit (2 weeks)
Correctly replace brace and demonstrate knowledge of locking/unlocking and flexion angles
Instruct on shoulder, wrist, and hand exercises
Isometric exercises for core
Phase 1 Physical Therapy (0-6 weeks): protect the joint, progress motion
NO open-chain exercises
Manual therapy 20+ minutes per session
Soft tissue mobilization, isometric exercises, core strengthening
Brace locked at 45° for 0-2 weeks, then may gradually unlock as passive motion improves
Progress passive and active-assisted ROM as tolerated after 2 weeks with the goal of symmetric full motion at 8-10 weeks.
Phase 2 Physical Therapy (6-12 weeks): progressive strengthening
Wean out of brace when demonstrating adequate upper extremity control and proprioception
Initiate biceps isometric strengthening
Proprioceptive training
Soft tissue mobilization, isometric exercises, core strengthening
Phase 3 Physical Therapy (12-24 weeks): return to pre-injury level and sport
Focus on functional exercises in all planes, advance only when fully controlled
Advance closed-chain and core strengthening
Proprioceptive training
Full return may take 4-6 months or more