Chronic Triceps Tendon Rupture Repair
PHASE I: Protect Repair (0 to 6 weeks)
SPLINT
- Maintain splint placed in OR for 2 weeks until first follow-up
- At first post-op visit, transition to custom removable splint to be worn at all times (except showering) until 6 weeks.
PRECAUTIONS
- Elbow immobilized in splint at 30° elbow flexion for 1st 6 weeks
- No active elbow extension 6 weeks
ROM
- Gradual ↑ Active/Passive ROM of shoulder in all planes while in splint
- Wrist/hand/finger full AROM in splint
STRENGTH
- Scapular retractions
- Shoulder shrugs
MODALITIES
- Hot pack before treatment
- E-stim, TENS as needed
- Ice 10-15 minutes after treatment
GOALS OF PHASE 1
- Control pain and inflammation
- Protect repair
- Independent in HEP
PHASE II: Progress Protected ROM and Function (6-12 weeks)
PRECAUTIONS
- Elbow placed in a hinged ROM brace allowing 30°-45°
- Brace to be worn at all times except during exercise or bathing
- Passive ROM ONLY for elbow extension
ROM
- Hinged Brace Range of Motion Progression (ROM progression may be adjusted base on Surgeon’s assessment of the surgical repair.)
- Week 6-7: 30°-45°
- Week 7-8: 15°-60°
- Week 8-9: 10°-90°
- Week 9-10: 0°-110°
- Week 10-11: 110°-125°
- Forearm: Initiate AAROM pronation and supination
- Progress to active pronation and supination (wk 6)
- Shoulder AROM as needed in brace
STRENGTH (in brace)
- Isometric shoulder exercises
- Supine/standing rhythmic stabilizations
- Wrist/hand: grip strengthening
- Standing flexion and scaption
- Side-lying ER
- Isometric biceps pain free (week 8)
MANUAL
- Scar mobilization
- Passive elbow extension
- Joint mobs as needed
MODALITIES
- Heat/hot pack before therapy
- US to incision as needed
- Ice 10-15 minutes
GOALS OF PHASE II
- Protection of repair
- Gradual increase in ROM
- Initiate strengthening to surrounding tissues
- Improve scapular stability
PHASE III: Reach full ROM (12-16 weeks)
ROM
- Week 12 progress to full ROM of elbow; discontinue brace if adequate motor control
- Initiate UBE light resistance
- Exercises
- Ball roll outs on table
- Wall walk
- Pulley
STRENGTH
- Tricep/elbow extension progression
- 6 weeks: initiate AROM
- 8 weeks: initiate light Theraband resistance
- Theraband IR/ER shoulder
- Theraband bicep extension
- Prone dumbbell Therex
- Rhythmic stabilization
MANUAL
- Passive elbow extension if lacking
- Joint mobs as needed to regain full flexion
- Week 14: Passive or contract relax to gain full flexion if still lacking
PHASE IV: Full ROM and Strength (>16 weeks)
STRENGTH:
- Progress strengthening program with increase in resistance and high-speed repetition
- Bicep curls with dumbbells
- Initiate IR/ER exercises at 90° abduction
- Progress rhythmic stabilization activities to include standing PNF patterns with tubing
- Initiate plyotoss – double arm progress to single arm
- Initiate sport specific drills and functional activities
- Initiate interval throwing program week 16-20
- Initiate light upper body plyometric program week 16-20
- Progress isokinetics to 90° abduction at high speeds
MODALITIES
- Ice 15-20 minutes
GOALS OF PHASE IV
- Full painless ROM
- Maximize upper extremity strength and endurance
- Maximize neuromuscular control
- Optimize shoulder mechanics/kinematics
- Optimize core stability
- Initiate sports specific training/functional training
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