What is the physical therapy protocol for triceps tendon repair?

Physical therapy following repair of the distal triceps brachii tendon typically involves several phases, each with specific goals aimed at restoring range of motion, strength, and function. The process may vary slightly depending on the severity of the injury, surgical technique, and individual patient factors. Here is an outline of a phased rehabilitation program for an athlete who undergoes triceps tendon repair surgery:

Phase 1: Protection (0-2 weeks)

  1. Precautions:
    • Brace locked at 20 degrees elbow flexion
    • No elbow active range of motion
  2. Goals:
    • Pain and edema management
  3. Progress Criteria:
    • Minimal to no edema
    • Shoulder passive range of motion 0-90 degrees
    • Elbow passive range of motion 0-20 degrees

Phase 2: Passive to Active-Assisted Range of Motion (2-6 weeks)

  1. Precautions:
    • No elbow active range of motion
    • No scar massage
  2. Goals:
    • Brace flexion lock progression (e.g., to 90 degrees at 4 weeks)
    • Scapular control
  3. Progress Criteria:
    • Full shoulder active range of motion
    • Full elbow passive range of motion

Phase 3: Active to Resisted Range of Motion (6-12 weeks)

  1. Precautions:
    • No elbow resisted extension
    • No shoulder rows
    • No upper extremity weightbearing
  2. Goals:
    • Normal scar mobility
    • Active elbow extension without lag
  3. Progress Criteria:
    • 5/5 shoulder strength
    • Full elbow active range of motion

Phase 4: Strength (12-16 weeks)

  1. Precautions:
    • Control eccentric triceps loading
    • No elbow plyometrics
  2. Goals:
    • Advance triceps strength
    • Upper extremity weightbearing progression
    • Running progression
  3. Progress Criteria:
    • 5/5 triceps strength
    • No 0 or 1 scores on the Functional Movement Screen (TM)
    • Plank hold 60 seconds
    • Side plank hold 30 seconds each side

Phase 5: Plyometrics and Sports (16+ weeks)

  1. Precautions:
    • Load management
    • Return to sport no sooner than 6 months post-op
  2. Goals:
    • Upper extremity plyometrics progression
    • Sport specific activity progression
  3. Discharge Criteria:
    • Pass Y-Balance (TM) test
    • Grip strength difference less than 5% bilaterally
    • Push-up competence
    • SANE score greater than 92%
    • Pass sport-specific testing

Early phases of rehabilitation are typically timeline-based, while later phases transition to criteria-based upper extremity testing to prepare the athlete for a safe return to sports participation. Throughout the rehab process, it’s vital to monitor progress closely, adjust interventions accordingly, and ensure open communication between the athlete, physical therapist, and medical team. The objective criteria for clearance to return to athletic participation should be based on a combination of subjective reports, functional assessments, and medical evaluation to ensure a safe and successful return to sport.

Reference: Chorba RS, Hu CG, Feldtmann JJ. Triceps Tendon Avulsion in a Soldier: A Case Report. Int J Sports Phys Ther. 2024;19(5):618-624. doi:10.26603/001c.116276

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