My original intention in starting the "Dr. Blue" series was to focus on injuries to our own team, but injuries to two players NOT on our team have piqued my interest.  So just as doctors do with their particularly infirm patients, Dr. Blue is going on the road to make some House Calls.  First up, Hattiesburg, MS…

Brett Favre, QB
Date of Injury: Unknown, likely in 2nd half of 2008 season
Nature of Injury: Partially torn right biceps tendon
Typical Rehab Process/Duration:  Depending on the severity of the tear either undergo surgery to clean up ro re-attach the tendon; or complete the tear through physical exercise or surgery.  Rehab to improve strength, flexibility and range of motion.  Recovery can take several weeks to months, up to 4 months to return to "heavy labor."
Players who have suffered similar injuries: John Elway, Norman Hand, Dusty Dvoracek

via www.greenpinstripes.com

In the first two thirds of the 2008 season, the Jets went 8-3 and Brett threw 20 TDs to 14 INTs.  But he started showing signs of injury in the final third, when he threw 2 TDs and 8 INTs on way to a 1-4 record.  On December 29, we learned that the source of his pain was his biceps tendon; and on February 11, presumably no longer able to play, he announced his Second Annual Retirement.  But not unsurprisingly, Favreapalooza has continued, and we've watched over the past several weeks as Favre has tried to throw, tried to rupture the tendon on his own, and finally undergo surgery sometime around June 1.

Brett's injury was interesting to me because of the constant remarks that a complete tear of the biceps tendon would not only NOT impact his ability, but it would actually relieve his pain.  As someone who last studied anatomy in high school (more than 20 years ago for those of you keeping score at home), this simply didn’t make sense to me.

On investigation this is what I learned… the biceps tendon connects the biceps muscle to the bone.  There is a distal biceps tendon at the elbow joint, and a proximal biceps tendon at the shoulder joint (About.com: Orthopedics).  Rupturing the distal biceps tendon results in loss of strength at the elbow, and a decreased ability to turn the forearm palm-up (such as to turn a door knob).  Injuring the proximal biceps tendon results in pain at the shoulder similar to what is experienced in a rotator cuff tear.  However, an injury to the proximal biceps tendon is not as devastating because it involves only ONE of two heads of the biceps tendon (hence the name "BI"ceps).  There is actually another tendinous attachment at the shoulder, so the muscle is still held to the bone.  Given what we know of Favre's symptoms, it is safe to assume his injury was a proximal biceps tendon tear.

Here's where it gets interesting… one side-effect of a ruptured proximal biceps tendon is that the biceps muscle bunches up in the arm, a condition known as "Popeye Muscle."  Here is a picture of what this looks like:

via orthoinfo.aaos.org

Let's just say I hope that if Brett does return to play in 2009, he wears a sleeve on his right arm at all times.

Given what we've seen in the media, and the Vikings' continued interest in Favre, I assume that we will see him return to play, and that he has every opportunity to look like Jet Favre of early 2008, not late 2008.  We can take a lesson from John Elway.  In 1997 Elway ruptured his biceps tendon in the exhibition opener in Mexico City on August 4.  He started throwing only 2 days later, and that year went on to win the Super Bowl… against Brett Favre and the Green Bay Packers.

Dr. Blue's Prognosis - Likelihood of Game 1 Appearance:  Medium