Table 2.

Postoperative biceps to triceps mobilization protocol

Immobilization phase	Patient is immobilized in long arm cast with elbow in full extension
1 to 3 wk post-op	Precautions: Avoid shoulder flexion above 90° and extension of shoulder beyond 0°
	Therapeutic intervention: Range of motion of uninvolved joints, edema control
Mobilization phase 3 to 12 wk post-op	Cast removed
	Precautions: Avoid shoulder flexion above 90° and extension of shoulder beyond 0° No passive elbow flexion Active elbow flexion and extension are progressed in increments of 15° elbow flexion each week Do not progress elbow flexion if extension lag is present No resistive exercises
	Splint Fabricate and provide elbow extension splint for night Continue nighttime extension splint until postoperative week 12 Fit with Bledsoe. To be worn during the day. Set elbow flexion block at 15° Adjust Bledsoe in increments of 15° of flexion as patient progresses. Do not increase range in brace if extension lag is present. Continue Bledsoe until the patient has achieved 90° elbow flexion and this range has been maintained for 1 week.
	Therapeutic intervention Active elbow flexion to 15°; active extension is to full Initiate exercises in an antigravity plane, blocking external rotation. Progress active elbow flexion in increments of 15° per week. Assess for extension lag. Decrease amount of flexion if extension lag is present. If lag is present, focus on end range extension. Edema control and scar management No passive elbow flexion before 3 months Strengthening—initiate light elbow extension at week 10
	Functional training
	Light functional training or activities may begin in allowed elbow ranges (pending time frame and assessment of allowed amount of elbow flexion) only after the therapist is sure the transfer is firing with the activity.