Intended for licensed physical therapists coordinating care with Dr. Vasileff. Defer to the operative note and the surgeon’s office for patient-specific direction.

Shoulder · Tendon

Biceps Tenodesis

Post-operative protocol · Dr. Chris Vasileff, MD

For the treating physical therapist. This protocol is a guideline; progression is criteria-based and individualized. Defer to the operative note and the surgeon’s office for patient-specific direction.

Sling for comfort, discontinue as tolerated
All ROM for weeks 0-6 performed with elbow flexed
May advance rehabilitation as rapidly as motion and pain allow

Phase I – Passive Motion (Week 1)

Pendulums to warm-up
Begin Active Scapular retraction/protraction exercises with therapist cueing
Full passive elbow flexion/extension
Full passive forearm supination/pronation
Passive shoulder range of motion per the following progression with the ELBOW FLEXED:
- - Involved hand to ipsilateral ear
  - Involved hand to back of head
  - Involved hand to mid-cervical spine
  - Involved hand to upper thoracic spine
  Progress to active ROM as tolerated after 2-3 days respecting the above progression with the elbow flexed
  - Ice: continue to ice on a regular basis. At least 20 minutes at a time, 4-5 times per day.
  - Shower: On post-op day 3
  - Appointment: your first therapy appointment should be within 5-7 days after your surgery.
  Phase II – Active Motion (Week 2-6)
  
  Continue with modalities and ROM outlined in Phase 1
  - - Active flexion and extension – full ROM allowed
    - Active forearm supination/pronation – full ROM allowed
    - Active shoulder range of motion as above with the elbow flexed
    *** NO RESISTED ELBOW FLEXION/SUPINATION UNTIL 6 WEEKS
    
    Phase III – Resisted (Week 7)Pendulums to warm up and continue with phase 2
    - Begin full active range of motion with elbow extended
    - Bicep curls
    - Resisted supination and pronation
    - External and Internal Rotation
    - Standing forward punch
    - Seated rows
    - Shoulder Shrugs
    - Bear Hugs
    *** NO RESISTED ELBOW FLEXION/SUPINATION UNTIL 6 WEEKS
    
    Phase IV – Weight Training (Week 8)
    - Light biceps curls/resisted supination gradually progressed to premorbid levels
    - Keep hands within eyesight, keep elbows bent
    - Minimize overhead activities
    - No military press, pull-downs behind head, or wide grip bench
    - Gradual progression of resistance controlling velocity, duration, intensity, and frequency
    RETURN TO ACTIVITIES
    
    Computer As soon as tolerated
    
    Driving When no longer taking narcotics
    
    Elliptical 1 week
    
    Jogging 3 weeks
    
    Light Swimming 1 month
    
    Golf (Chip & Putt) 1 month
    
    Golf (Irons & Driver) 2 months
    
    Tennis 2 months
    
    Swinging Bat 2 months
    
    Return to Throwing 2-3 months
    
    Weight training 2-3 months
    
    Skiing 3 months
    
    Full-Speed Pitch 3 months
    
    Contact Sports 4 months
    
    **Heavy overhead lifting (military press), pull-down behind head, wide grip bench and dips are discouraged.

Questions about a protocol? Contact Dr. Vasileff’s office at (704) 865-0077.