Bicep Tendon Reattachment Surgery

Bicep tendon reattachment surgery is a procedure to repair a torn or ruptured bicep tendon by anchoring it back to the bone.¹ This surgery is most commonly performed to restore strength and function after a complete tear, which typically occurs either at the elbow or the shoulder.

Types of Reattachment Surgery

The procedure differs significantly depending on where the tear occurred:

1. Distal Biceps Repair (Elbow)²

This is the most common “reattachment” surgery. The distal tendon connects the bicep muscle to the radius bone in your forearm.³

Why it’s done: Without surgery, you may lose 30–50% of your forearm twisting strength (like using a screwdriver) and about 30% of your elbow flexion strength.
Urgency: This should ideally be done within 2–3 weeks of the injury.⁴ If delayed, the tendon can retract and scar, making it harder to pull back down to the bone.⁵+1

2. Proximal Biceps Tenodesis (Shoulder)⁶

This involves the “long head” of the bicep tendon at the shoulder.⁷

Why it’s done: Often performed if non-surgical treatments fail to resolve chronic pain or if there are concurrent injuries like rotator cuff tears.⁸
Procedure: Instead of reattaching it to the original spot (the labrum), surgeons often anchor it to the upper arm bone (humerus) to alleviate pain and prevent the “Popeye” muscle bulge.⁹

How the Procedure Works

The surgery is typically an outpatient procedure performed under general or regional anesthesia.¹⁰

Incision: A small incision is made at the front of the elbow or shoulder.¹¹
Preparation: The surgeon locates the torn tendon and “freshens” the end by removing damaged tissue.¹² A small hole is drilled into the bone where the tendon originally sat.¹³+1
Fixation: The tendon is secured using specialized hardware.¹⁴ Common methods include:
- Suture Anchors: Tiny screws with heavy-duty threads.¹⁵
- Biceps Buttons: A small metal “toggle” that flips on the far side of the bone to lock the tendon in place.¹⁶
- Interference Screws: A screw that wedges the tendon directly into the bone socket.¹⁷

Recovery Timeline

Recovery is a gradual process that focuses on protecting the repair while slowly regaining motion.¹⁸

Phase	Timeframe	Activity
Immobilization	Weeks 0–2	Arm is kept in a sling or splint to protect the stitches.
Early Motion	Weeks 2–6	Passive physical therapy begins (the therapist moves your arm for you).
Active Use	Weeks 6–12	You start moving the arm on your own; no heavy lifting yet.
Strengthening	Months 3–4	Resistance training and light weights are introduced.
Full Activity	Months 6–9	Return to heavy labor, sports, and full lifting.

Potential Risks

While generally successful, risks include:

Nerve Irritation: Temporary numbness in the forearm is common (up to 20% of cases) because nerves run very close to the surgical site.¹⁹
New Bone Formation: Occasionally, the body grows extra bone (heterotopic ossification) in the area, which can limit movement.
Re-rupture: This is rare (approx. 2%) but can happen if the arm is loaded too heavily too soon.

Would you like me to look up specific physical therapy protocols for a distal bicep repair?

Yes

Physical therapy for a distal bicep repair is a marathon, not a sprint. The goal is to allow the tendon to “knit” into the bone securely before you ever try to flex the muscle against weight.

Most protocols are divided into three or four distinct phases. Note: Always follow your specific surgeon’s protocol, as the “tightness” of the repair often dictates how fast you can progress.

Phase 1: Protection & Early Motion (Weeks 0–2)

The priority here is protecting the surgical site while keeping the surrounding joints (hand, wrist, shoulder) moving.

Bracing: Usually locked in a splint or hinged brace at 90 degrees.
Exercises:
- Hand/Grip: Squeezing a ball or putty to maintain blood flow and forearm muscle tone.
- Wrist ROM: Gentle flexion and extension of the wrist.
- Shoulder ROM: Active movement of the shoulder (shrugs, circles) to prevent “frozen shoulder,” but strictly avoiding reaching back (shoulder extension).

Phase 2: Controlled Range of Motion (Weeks 2–6)

This phase introduces the hinged elbow brace, which acts like a “governor” to prevent you from straightening your arm too far.

Bracing: The brace is typically opened by 10°–15° per week. For example:
- Week 2: 45° to full flexion.
- Week 4: 30° to full flexion.
- Week 6: Full extension (0°) reached.
Exercises:
- Passive ROM (PROM): Using your “good” arm to gently move the surgical arm into flexion and extension within the brace limits.
- Passive Supination: Using the other hand to rotate your palm up (supination) without using the bicep muscle.
- Active Extension: You can use your tricep to straighten the arm, but you must not use the bicep to pull it back up yet.

Phase 3: Active Motion & Light Loading (Weeks 6–12)

By week 6, the tendon is usually stable enough to begin moving the arm under its own power (gravity only).

Bracing: Typically discontinued by week 6 or 8.
Exercises:
- Active ROM (AROM): Moving the elbow through its full range without any outside weight.
- Shoulder/Scapular Strengthening: Starting rows or “TYWs” with light bands to stabilize the shoulder blade.
- Light Isotonics (Weeks 8–10): Starting with very light weights (1–2 lbs) for “hammer curls” or wrist curls, but only if cleared by the surgeon.

Phase 4: Strengthening (Weeks 12+)

This is where you begin rebuilding the lost muscle mass.

Resisted Bicep Curls: Usually start with light resistance (bands or 5lb dumbbells) and progress slowly.
Full Functional Use: Return to “unrestricted” lifting usually occurs between 4 to 6 months.

Critical Restrictions

To avoid a “re-rupture” (which usually happens in the first 6 weeks), you must strictly follow these rules:

No Active Flexion: Do not use the bicep to lift even a cup of coffee for the first 4–6 weeks.
No Forceful Supination: Avoid the “screwdriver” motion (twisting the palm up) against any resistance.
No Reaching Back: Avoid extending your shoulder behind your body, as this puts maximum tension on the new attachment.

Would you like me to find a list of specific “safe” exercises for the 6-to-12-week strengthening phase?

Yes

During the 6-to-12-week window, the tendon is “anchored” but not yet “integrated.” The goal of this phase is to transition from a therapist moving your arm to you moving it yourself, while keeping the load extremely light to avoid “creeping” or stretching the repair.

Most surgeons follow a “Rule of 5s” here: No lifting anything heavier than 5 lbs (like a bag of flour) until week 12.

1. Mobility & Range of Motion (Weeks 6–8)

At this stage, you are regaining full motion without the brace. These exercises use the weight of your arm alone.

Active Elbow Flexion/Extension: Sitting or standing, slowly bend your elbow to touch your shoulder and then straighten it fully. Do this smoothly, without jerky movements.
“Hammer” Rotations: With your elbow tucked at your side and bent at 90°, rotate your palm to face up (supination) and then down (pronation). Think of the motion of turning a doorknob.
Wall Slides: Stand facing a wall. Place your hands on the wall and slowly slide them up as high as possible, then back down. This regains shoulder mobility without straining the bicep.

2. Scapular & Shoulder Stabilization

Since you haven’t used your arm much, the muscles around your shoulder blade have likely weakened. Strengthening these provides a “base” for your bicep.

Scapular Squeezes: Stand tall and “pinch” your shoulder blades together and slightly down, as if trying to tuck them into your back pockets. Hold for 5 seconds.
Prone Rows (Gravity Only): Lie face down on a bed with your arm hanging off the side. Pull your elbow up toward the ceiling, focusing on squeezing your shoulder blade, then lower it. Do not use weights yet.
Internal/External Rotation (Bands): Use a very light resistance band. Keep your elbow tucked into your side (put a rolled-up towel between your elbow and ribs to keep it in place) and rotate your hand outward away from your stomach.

3. Light Loading (Weeks 8–12)

If your surgeon clears you, you may begin “sub-maximal” loading—meaning you are barely challenging the muscle.

Grip Strengthening: Continue using a stress ball or therapeutic putty. Hand strength is directly linked to forearm and bicep stability.
Tricep Press-downs: Using a light band or very light weight, focus on straightening the arm. This strengthens the “opposite” muscle of the bicep, which helps stabilize the elbow joint.
Bicep Isometrics (The “No-Movement” Curl): Bend your elbow to 90°. Use your other hand to provide slight resistance as you try to curl up, but don’t actually let the arm move. This “wakes up” the bicep fibers without pulling on the tendon attachment.

Red Flags to Watch For

During this phase, “soreness” in the muscle is normal, but sharp pain at the surgical site is a sign to stop immediately.

The “Popeye” Sign: If you notice a sudden bunching of the muscle or a new deformity, contact your surgeon.
Increased Warmth/Swelling: A sign that you are progressing too fast and the tissue is becoming inflamed.