| Time | Day 0 | 0–2 weeks | 2–4 weeks | 4–6 weeks | 6–12 weeks | 12+ weeks |
| Immobilisation & Protection | Shoulder immobiliser sling (often for comfort only). Elbow may be free or in soft dressing. | Sling worn continuously (usually 3–4 weeks) if tenodesis; less strict if tenotomy. No resisted biceps. | Sling wean (around 3–4 weeks). Continue to avoid forceful elbow flexion or heavy lifting. | Sling off. Elbow mobilising freely; avoid heavy loads. | Full use of arm; exercise caution with heavy biceps loading. | Return to all activities; permanent guidelines limiting stress on biceps. |
| Mobilisation/Exercises | Hand/wrist/elbow movements as tolerated; gentle pendulums at home (if tenodesis). | Elbow flexion/extension PROM and active within pain-free range. Avoid resisted flexion/supination[14]. Shoulder scapular exercises. | Gradually increase elbow ROM to full flex/ext; start AAROM. Begin gentle grip and distal exercises. | At ~6 weeks, full AROM achieved. Initiate light isometric biceps work (end of Phase II)[18]. Continue cuff/scap strengthening. | At ~8–12 weeks, introduce light resistance exercises for biceps/forearm (e.g. band curls). Progress shoulder strengthening. | Gradually return to all exercises; heavy lifting and high-demand biceps use only as tolerated. |
| Activity | Protect repair; elbow remains mostly immobilised. | ADLs allowed (feeding, grooming) with arm supported at waist level. No lifting. | Light use of arm; occasional daily tasks (e.g. writing) without pain. | Begin resuming moderate tasks; avoid repetitive heavy use. | Return to work duties (lifting <5–10 kg) ~3 months. Recreational activities (golf, tennis) by 3–4 months. | Full sports work around 4–6 months, based on strength; contact/throwing gradually after strength is restored. |
Key clinical points: In tenodesis, the biceps origin is moved and fixation must heal. Sling immobilisation for ~3–4 weeks is common. Resisted elbow flexion and forearm supination are avoided for ~6 weeks. Shoulder ROM (flexion/abduction) is maintained but without aggressively using the biceps (no heavy lifting or resisted curls). The [UVA] protocol recommends passive ROM early and progression to active only after 6 weeks, with criteria-based strengthening (e.g. 80% contralateral strength)
Movement restrictions: No heavy lifting, pushing or pulling with the arm for 6–8 weeks. No weighted biceps curls or chin-ups for at least 3 months. Avoid combined elbow extension and forearm supination early (to protect repair).
Return to function: Sedentary work ~2–4 weeks. Manual/light work by 6–8 weeks (if pain-free, avoiding heavy lifts). Sports involving the arm (e.g. racquet sports, contact) by ~3–4 months, progressively.
