Rehabilitation Guidelines for Biceps Tenodesis  
 
This protocol is intended to guide clinicians through the post-operative course for biceps tenodesis. This protocol is time 
based (dependent on tissue healing) as well as criterion based. Specific intervention should be based on the needs of the 
individual and should consider exam findings and clinical decision making. The timeframes for expected outcomes 
contained within this guideline may vary based on surgeon’s preference, additional procedures performed, and/or 
complications. If a clinician requires assistance in the progression of a post-operative patient, they should consult with 
the referring surgeon. 
 
The interventions included within this protocol are not intended to be an inclusive list of exercises. Therapeutic 
interventions should be included and modified based on the progress of the patient and under the discretion of the 
clinician.  
 
Considerations for the Post-operative Biceps Tenodesis 
Many different factors influence the post-operative biceps tenodesis rehabilitation outcomes, including pre-operative 
tissue quality, shoulder range of motion, arm strength, and function. Other individual considerations include patient age 
and co-morbidities, such as: increased BMI, smoking, and diabetes. It is recommended that clinicians collaborate closely 
with the referring physician regarding specific range of motion or loading guidelines for each individual case. 
 
If the patient develops a fever, unresolving numbness/tingling, excessive drainage from the incision, uncontrolled pain, 
or any other symptoms you have concerns about you should contact the referring physician. 
 
PHASE I: IMMEDIATE POST-OP: Passive Range of Motion Phase (1-4 WEEKS AFTER 
SURGERY) 
Rehabilitation 
Goals 
• Protect repaired biceps tendon. 
• Minimize shoulder pain and inflammatory response. 
• Keep incisions clean and dry. 
• Restore passive range of motion (PROM) of shoulder and elbow. 
• Adequate scapular function. 
Sling 
• Wear sling as directed by surgeon.  
• Wean out of sling starting 3 weeks post-op 
Precautions 
• No active range of motion (AROM) of the elbow or shoulder. 
• No shoulder external rotation beyond 40 degrees. 
• No shoulder extension or horizontal abduction past neutral. 
• Place a towel roll or pillow under elbow while laying supine to avoid shoulder extension  
• No lifting objects. 
• No friction massage to the proximal biceps/tenodesis site. 
Intervention 
Range of motion/Mobility  
• PROM of elbow for flexion/extension, supination/pronation. 
• AROM of wrist/hand 
• Shoulder PROM: avoid shoulder ER past 40 degrees and no shoulder extension beyond neutral 
 
Strengthening 
• Scapular retractions and mobility exercises  
• Ball squeezes 
Criteria to 
Progress 
• Appropriate healing of surgical incision. 
• Adequate pain control. 
• Full PROM of shoulder and elbow. 
 
 
 
PHASE II: INTERMEDIATE POST-OP: ACTIVE RANGE OF MOTION PHASE (4-6 WEEKS AFTER 
SURGERY) 
Rehabilitation 
Goals 
• Minimize shoulder pain and inflammatory response. 
• Achieve gradual restoration of shoulder and elbow AROM. 
• Begin light waist-level functional activities. 
• Initial submaximal shoulder isometrics 
• Return to light computer or desk work. 
Precautions  
• No lifting with affected upper extremity. 
• No loading to biceps, elbow flexors, supinators. 
• No friction massage to the proximal biceps tendon/tenodesis site. 
• No running. 
• Avoid over stressing repaired tissue with stretching or manual therapy 
Additional 
Intervention 
*Continue with 
Phase I 
interventions 
Range of motion/Mobility 
• Shoulder AAROM 
- Lawn chair AAROM 
- Shoulder ER  
- Rail slides 
- Wall slides 
• Shoulder AROM 
- Supine shoulder flexion  
- Standing scaption 
- Shoulder ER in neutral 
- Shoulder ER @ 90 degrees supported on table 
• Elbow AROM 
- Active elbow flexion 
- Active elbow extension 
- Forearm supination 
- Forearm pronation 
 
Strengthening  
• Shoulder Isometrics 
- Flexion, extension, ER, IR, abduction  
 
Manual Therapy 
• Glenohumeral, scapulothoracic, and trunk joint mobilizations as indicated (Grade I-IV) 
• Posterior capsule stretching 
- Cross body stretching 
- Sleeper Stretch  
 
Cardiovascular exercise 
• Walking or stationary bike - avoid excessive weight bearing through affected arm. No 
distractive forces on shoulder 
Criteria to 
Progress 
• Full AROM of shoulder and elbow. 
• Proper scapular mechanics with ROM and functional activities. 
• Adequate pain control. 
 
PHASE III: LATE POST-OP: INITIAL STRENGTHENING PHASE (6-8 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Normalize strength, endurance, neuromuscular control. 
• Return to chest-level activities. 
Precautions 
• No strengthening or functional activities until near full ROM is achieved. 
• Avoid long-lever arm resistance for elbow flexion and supination. 
Additional 
Intervention 
Strengthening 
• Continue shoulder and elbow PROM and AROM 
• Initiate Resisted Biceps curls 
 
 
*Continue with 
Phase I-II 
Interventions  
• Initiate Resisted supination 
• Resisted Triceps extension 
• Resisted wrist extension/Resisted wrist flexion  
• Continue shoulder isometrics 
- Progress resistance as tolerated 
• Rhythmic stabilizations 
Criteria to Progress 
• Full shoulder and elbow AROM. 
• Good tolerance to initial strengthening without increase in symptoms. 
 
PHASE IV: Advanced Strengthening (8-12 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Maintain full pain-free shoulder and elbow AROM. 
• Progress shoulder and elbow strength. Focus on low load, high repetitions (30-50). Open and 
closed chain strengthening. 
Additional 
Intervention 
*Continue with 
Phase I-III 
interventions 
Strengthening 
• Resisted IR in neutral 
• Resisted ER in neutral 
• Resisted shoulder IR in elevation 
• Resisted shoulder ER in elevation 
• Full can scapular plane arm elevation 
• Side-lying ER  
• Prone Rowing 
- 30/45/90 degrees abduction 
• Push up plus progression (wall, counter, knees on floor, floor) 
• Resisted PNF Diagonals 
 
Cardiovascular exercise 
• Can initiate return to running 
• No swimming 
Criteria to 
Progress 
• 5/5 shoulder and elbow strength. 
• Full shoulder AROM in all planes. 
• Good tolerance to strengthening exercise without increase in symptoms. 
 
PHASE V: RETURN-TO-SPORT (12-16 WEEKS AFTER SURGERY) 
Rehabilitation 
Goals 
• Progress strength and function of involved upper extremity. 
• Return to normal sport or work activities. 
• Maintain pain-free ROM. 
• Avoid excessive anterior capsule stress. 
Additional 
Intervention 
*Continue with 
Phase II-IV 
interventions 
Strengthening/Sport Specific training 
• Initiate plyometric training starting with below shoulder level and progressing to overhead: 
Weighted ball drop/catch in standing, chest pass, overhead ball dribble against wall, prone 
90/90 ball drop/catch, prone Y ball drop/catch, prone T ball drop/catch 
• Multi joint/compound strengthening 
• Interval return to sport specific training 
Criteria to 
Progress 
• No pain with progressive strengthening.  
• 90% strength of involved extremity compared to uninvolved side with dynamometry testing 
• Within normal limits with field testing if applicable (e.g. closed kinetic chain upper extremity 
stability test, single arm seated shot-put test, ASH test/Modified ASH test). 
• Low level to no disability with patient reported outcome measure (e.g. Quick DASH). 
 Revised October 2021 
 
Contact 
Please email MGHSportsPhysicalTherapy@partners.org with questions specific to this protocol 
 
References: 
 
 
 
1. 
Galasso, O., Gasparini, G., De Benedetto, M., Familiari, F., & Castricini, R. (2012). Tenotomy versus Tenodesis in the treatment of the long head of 
biceps brachii tendon lesions. BMC Musculoskeletal Disorders, 13, 2005. doi:10.1186/1471-2474-13-205 
2. 
Krupp RJ, Kevern MA, Gaines MD, Kotara S, Singleton SB. Long Head of the Biceps Tendon Pain: Differential Diagnosis and Treatment. Jour Ortho & 
Sports PT. Feb 2009; 39(2): 55-70 
3. 
Ryu JH, Pedowitz RA. Rehabilitation of biceps tendon disorders in athletes. Clin Sports Med. 2010 Apr;29(2):229- 46, vii-viii. doi: 
10.1016/j.csm.2009.12.003 
 
 
 
 
