Rehabilitation Isolated Biceps Tenodesis


This information is general and may vary from case to case. Your physiotherapist will guide you through the process. There are many different exercise and therapy regimes.
After surgery it is important for the repair site to remain reasonably still to promote healing. However staying in a sling for
prolonged periods will cause severe stiffness.
Therefore limited gentle range of motion is allowed at first and then built up
Strengthening the arm is avoided until healing has occurred
Take some painkillers about 30min before you do your exercises
Ice should be applied (wrapped in a cloth NOT APPLIED DIRECTLY TO THE SKIN) for 20 minutes every 2 hours in the first
2 weeks.
Do 10 of each exercise 4 times per day.
Do not push through the pain barrier or try and do extra repetitions
If a biceps tenodesis is performed as a part of a rotator cuff repair follow the rotator cuff repair protocol

WEEK 0-2


Posture: Shrug your shoulders then roll them backwards and downwards, pinching your shoulder blades together.
Hold for 5 seconds
Try to maintain this position throughout the day
Hand & Wrist: Keep your arm in the sling and move your hand up and down at the wrist. Clench and unclench your fist.
Squeezing a soft ball can help.
Forearm: With your arm in the sling and the elbow bent at your side, turn the hand to face the ceiling and then the ground.
Elbow: Take your arm out of the sling, bend and straighten the elbow.
Do not push through the pain.
If bending your elbow is too painful then use your other arm to bend it.
Your elbow will not fully straighten at this point and it will feel very tight as you extend.
Do not force it straight and do not use your other arm to straighten it.
Stacks Image 399471

Fig 1

Pendulum shoulder flexion: see fig 1
Undo waist strap of sling
Bend forward at your waist. Let your (operated) arm relax and hang
straight down
Use your good arm to bring your operated arm back in
Then slowly release and let the operated arm hang forward again
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Fig 2

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Fig 3

Assisted shoulder external rotation to neutral: see Fig 2 and Fig 3
Lie on your back
Bend your elbows and keep them tucked in to your sides
Using your good arm push rotate your operated hand outwards until the
operated hand is pointing to the ceiling

WEEK 2-6


Your first post-operative visit is at two weeks
Continue elbow exercises
Continue to wear the sling between exercises
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Fig 4

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Fig 5

Passive forward elevation as pain allows: see Fig 4 and Fig 5
Lie on your back. Lock the fingers of each hand together.
Use your good arm to pull the other hand up towards and then above your head
Then straighten your elbow, Hold for 5-10 seconds
Bend your elbows and then gently return to the start position
As pain improves this exercise can be performed in the sitting position
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Fig 6

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Fig 7

Assisted shoulder external rotation as able: see Fig 6 and Fig 7
Lie on your back, Bend your elbows and keep them tucked in to your sides
Hold a stick in each hand a shoulder width apart
Using your good arm rotate your operated arm outwards as far as comfortable
Hold for 5-10 seconds
Stacks Image 418401

Fig 8

Stacks Image 418406

Fig 9

Combined internal and external rotation lying: see Fig 8 and Fig 9
Lie on your back, grasp a stick with both hands, shoulder width apart,
Rock the bar as far as you can from side to side
This exercise can be done sitting with your elbows resting on a table
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Fig 10

Stacks Image 418448

Fig 11

Flexion – sitting: see Fig 10 and Fig 11
Sit facing a table, Rest your hands on the table
Slide both hands forward as far as possible bending at the waist,
This exercise can be performed standing and sliding your hands up a wall
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Fig 12

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Fig 13

Flexion in lying position with bar: see Fig 12 and Fig 13
Lie on your back, grasp a stick with both hands, shoulder-width apart
Start with stick resting across your hips,
Lift your arms over your head keeping them straight
Stacks Image 399553

Fig 14

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Fig 15

Shoulder extension standing: see Fig 14 and Fig 15
Stand holding a stick behind your back with both hands
Lift the stick backwards away from your back
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Fig 16

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Fig 17

Internal rotation standing: see Fig 16 and Fig 17
Hold a stick behind your back as shown with your good arm at the top
Use your unaffected arm to pull your operated arm up your back as far as possible
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Fig 18

Pulleys: see Fig 18
Sitting position.
Hold the pulley handles in each hand and use the unaffected arm to pull the affected arm up
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Fig 19

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Fig 20

Combined external rotation and flexion in sitting: see Fig 19 and Fig 20
Sit in a chair
Clasp both hands behind your head
Push both hands up to the ceiling
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Fig 21

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Fig 22

Isometric exercises in neutral External rotation: Sit with or without your arm supported on
a table and with your elbow bent to 90. Place a rolled up hand towel under your armpit. Place
the unaffected hand on the outside of the forearm at wrist level and push against it, to 30% of
maximum resistance
Abduction: Sit with or without your arm supported on a table. Keep your elbow by your side,
place the hand of the unaffected arm on the outside of the upper arm and push into it, to 30%
of maximum resistance
Internal rotation: In sitting with or without your arm supported on a table. Place a rolled up
hand towel under your armpit. Place the unaffected hand on the inside of the forearm at wrist
level and push against it, to 30% of maximum resistance.

6-12 weeks


Week 6 - 12: Continue Elbow Exercises. You may start to use the arm for light activity as tolerated
Stacks Image 410194

Fig 23

Shoulder flexion: see Fig 23
Stand on the band
Grasp the band with arm at side
elbow straight, thumb up
Raise arm in front over-head, keeping elbow straight
Slowly return to starting position
Stacks Image 410213

Fig 24

Shoulder abduction: Fig 24
Stand on the band
Grasp the band with arm at side
elbow straight, thumb up
Raise arm upwards to the side, keeping elbow straight
Slowly return to starting position
Stacks Image 410227

Fig 25

Shoulder extension: see Fig 25
Secure band at waist level around a door handle or rail
Grasp band and pull backwards keeping elbow straight
Slowly return to starting position
Stacks Image 410241

Fig 26

Internal rotation: see Fig 26
Secure band at waist level around a door handle or rail
Stand with operated side to band
Elbow bent to 90 degrees arm at side
Grasp elastic and pull inwards across the body
Stacks Image 410255

Fig 27

External rotation: see Fig 27
Secure band at waist level around a door handle or rail
Place pillow between elbow and body
Stand with operated away from band
Elbow bent to 90 degrees arm at side
Grasp elastic and rotate arm outwards
Shoulder blade retraction / rows
Secure band at waist level around a door handle or rail
Grasp band in both hands, elbows bent to 90 degrees, thumbs up
Bring arms out 45 degrees from body
Pull band backwards, pinching your shoulder blades together in a rowing type action,
Hold shoulder blades together for 5 seconds

PHONE
(02) 9587 4720

Sydney Orthopaedic Trauma and Reconstructive Surgery
Suite 5, Level 2
19 Kensington Street
Kogarah NSW 2217

Orthopaedic & Arthritis Specialist Centre
Level 2, Gallery Arcade
445 Victoria Avenue
Chatswood NSW 2067