Triceps Tendon Repair Protocol

Rehabilitation after distal triceps tendon repair is a structured progression designed to protect the healing tendon repair while slowly recovering elbow range of motion, strength, and function. The triceps muscle is the primary extensor of the elbow, and distal triceps tendon ruptures are relatively rare but require surgical repair to restore extension strength. Because the repair must withstand active extension forces, rehabilitation requires careful coordination between patient, physical therapist, and surgeon.

Phase 1: Protection & Early ROM (Weeks 0-2)

• Goals:
  • Protect the surgical repair and incision.
  • Control post-operative pain and edema.
  • Maintain range of motion in the shoulder, wrist, and hand.
• Precautions & Restrictions:
  • Keep the elbow immobilized in the splint or locked brace (typically at 30 to 45 degrees of flexion).
  • Strictly no active elbow extension (no triceps contraction).
  • No weight bearing or lifting with the surgical arm.
  • Keep incision clean and dry.
• Suggested Exercises:
  • Active and passive range of motion of the hand, wrist, and fingers.
  • Shoulder range of motion (pendulum exercises, active-assisted flexion/abduction as tolerated) while keeping the elbow supported.
  • Gentle shoulder shrugs and scapular retraction.
• Criteria to Progress:
  • At least 2 weeks post-surgery.
  • Healed surgical incision with no signs of infection.
  • Minimal pain and swelling.

Phase 2: Progressive Range of Motion (Weeks 2-6)

• Goals:
  • Gradually increase passive and active-assisted elbow range of motion (ROM).
  • Protect the repair from excessive loading.
  • Initiate light, gravity-assisted active range of motion.
• Precautions & Restrictions:
  • Wear hinged elbow brace at all times except during therapy. Brace is typically unlocked gradually (e.g., Weeks 2-4: 0-60 degrees; Weeks 4-6: 0-90 degrees).
  • No active elbow extension against resistance.
  • No passive flexion beyond the limits specified by the surgeon (usually capped at 60 degrees in week 3, 90 degrees in week 4, and 110-120 degrees by week 6).
  • No lifting or weight bearing.
• Suggested Exercises:
  • Passive and active-assisted elbow flexion (within specified limits).
  • Active elbow flexion (gravity-assisted).
  • Active-assisted elbow extension (using the non-operative arm to guide the elbow back to straight).
  • Forearm pronation and supination in comfortable ranges.
  • Submaximal isometric biceps and forearm exercises (no triceps activation).
• Criteria to Progress:
  • At least 6 weeks post-surgery.
  • Elbow range of motion achieved to at least 90-110 degrees of flexion.
  • No increase in pain or instability.

Phase 3: Active ROM & Initial Strengthening (Weeks 6-12)

• Goals:
  • Discontinue the hinged elbow brace (typically around week 6-8).
  • Restore full active range of motion in elbow flexion and extension.
  • Begin light, progressive strengthening of the triceps and surrounding muscles.
• Precautions & Restrictions:
  • Avoid sudden, jerky extension movements or heavy lifting.
  • No heavy resisted triceps exercises or push-ups.
  • Monitor for posterior elbow pain or swelling, which may indicate overloading the tendon.
• Suggested Exercises:
  • Progress to full active range of motion in elbow flexion and extension (gravity-resisted).
  • Begin light triceps strengthening around week 8, starting with submaximal isometrics at various angles (e.g., 30, 60, 90 degrees).
  • Progress to light concentric extension exercises using resistance bands or very light weights (1-2 lbs) through a pain-free range.
  • Biceps, forearm (pronation/supination), and shoulder strengthening (rotator cuff and scapular stabilizers).
• Criteria to Progress:
  • At least 12 weeks post-surgery.
  • Full active range of motion in elbow extension and flexion without pain.
  • Good baseline strength in flexion and forearm rotation.

Phase 4: Advanced Strengthening & Return to Activity (Weeks 12-24)

• Goals:
  • Restore full triceps strength and endurance.
  • Incorporate functional, multi-joint exercises.
  • Gradual return to work, sports, and recreational activities.
• Precautions & Restrictions:
  • Avoid sudden overloading of the triceps; load progression should be slow and controlled.
  • No high-impact sports or heavy lifting until cleared by the surgeon (usually 4 to 6 months post-op).
• Suggested Exercises:
  • Progressive resistance training for the triceps (triceps pressdowns, overhead extensions, dumbbell extensions).
  • Introduce eccentric triceps strengthening to build tendon resilience.
  • Closed-kinetic chain exercises (modified push-ups against a wall or counter, progressing to floor push-ups and planks as tolerated).
  • Sport-specific or work-specific functional training.
• Criteria for Return to Activity:
  • Full, pain-free active range of motion.
  • Triceps strength at least 85-90% of the uninvolved side.
  • Surgeon clearance for full unrestricted activity.

These guidelines represent a standard rehabilitation protocol. Individual recovery rates vary significantly depending on the size of the repair, bone/tissue quality, and general patient health. Your surgeon may modify this protocol specifically for you.

Disclaimer: This protocol is for educational purposes and is not a substitute for professional medical advice. Always consult your surgeon or physical therapist before performing any exercises or modifying activity restrictions.