After your surgery · Nicholas Genovese, M.D.
Distal biceps repair
Repair of the biceps tendon near the elbow
Weeks 6–12 therapy guide
This is a later-phase guide, not a day-of-surgery handout
This page contains the phase-specific material currently available for this procedure. Use the printed instructions from your surgery for wound care, splinting, medicines and the first weeks of recovery. Begin this guide only after your surgeon or therapist clears you.
If you need the current day-of-surgery handout, call (858) 560-0242.
Strengthening from weeks 6 to 12
Use concentric, submaximal strengthening only. Do not begin eccentric elbow-flexion or supination exercises until approximately 12 weeks and only after clearance.
Begin with 1 to 2 pounds or a light resistance band. Perform 2 to 3 sets of 10 to 15 repetitions once daily.
Move slowly without momentum or swinging. Finish each set feeling that you could complete several more repetitions.
Increase resistance by about 10 percent per week only when symptoms remain controlled.
Supination progression
Give special attention to turning the palm upward. Begin each repetition from a palm-down position.
Progress from gentle isometric holds at several angles to concentric motion through the available range, then to functional movement patterns.
For a finely graded lever-arm exercise, hold a light hammer or wrench close to its head. As strength improves, move the hand gradually farther down the handle without increasing the tool's weight.
Measure and work on both pronation and supination motion instead of assuming rotation will return on its own.
Other areas to address
Include controlled elbow flexion, elbow extension and pronation strengthening.
Work on regaining full terminal elbow extension if a deficit remains.
Include grip, forearm, shoulder-blade and rotator-cuff conditioning within the restrictions provided by your care team.
Use scar mobilization or desensitization only after the incision has healed and when directed.
Reassessment at approximately 12 weeks
Your care team should confirm full motion, pain-free progressive concentric loading and no repair-site pain with resisted supination before advancing.
After clearance, eccentric exercise, side-to-side strength comparison and occupation- or sport-specific conditioning can begin gradually.
Therapy guidance
- This progression applies from weeks 6 through 12 after an acute primary distal biceps repair. Follow it only after your surgeon or therapist clears you to begin strengthening.
- Use slow, controlled movement. Muscle soreness can occur, but pain at the repair site in the front of the elbow means the load should be reduced and your care team contacted.
Activity and lifting limits
- From weeks 6 through 12, do not lift or carry more than 10 pounds with the operated arm during exercise or daily activity.
- Do not perform heavy pushing, pulling, carrying, catching or sudden reactive movements.
- Do not perform push-ups, planks or other weight-bearing exercise through the operated arm.
- Do not perform maximal strength testing before approximately 12 weeks.
When to call the office
Call the office at (858) 560-0242 immediately if you have any of the following:
- Fever above 101.0 °F or chills
- Redness, warmth or red streaks spreading from the incision
- Drainage from the incision, especially cloudy or bad-smelling drainage
- Pain that is getting worse or is not controlled by your medicines
- New or worsening numbness, tingling or weakness
- Fingers that turn blue, white or cold, or stay very swollen after elevating your hand for an hour
- A splint or wrap that still feels too tight after you loosen the outer elastic wrap and elevate your hand
- Bleeding that soaks through the dressing
- A pop or tearing sensation, or a sudden loss of elbow-flexion or palm-up strength
- Pain at the repair site in the front of the elbow that increases as resistance increases
- Elbow or forearm rotation that is becoming more limited instead of improving
- New or worsening weakness when extending the wrist or fingers
- Persistent or worsening numbness, tingling or burning along the outer forearm
If you cannot reach us and the problem is urgent, go to the nearest emergency room or call 911.
Call 911 or go to the nearest emergency room for chest pain, trouble breathing, or new calf pain or swelling.
About these instructions
These instructions are general guidelines for patients of Nicholas Genovese, M.D. Your surgeon may change your plan based on your surgery and how you are healing. If anything here differs from what your surgeon or therapist told you, follow their instructions, and call the office before changing any activity, splint use or therapy.