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Wednesday, November 5, 2008
Bell: Full recovery a realistic prognosis for Brodeur

By Stephania Bell
ESPN.com

The New Jersey Devils will be depending on the services of goaltender Kevin Weekes for the next few months since Martin Brodeur, who prior to this injury had a streak of 56 consecutive starts, will undergo surgery Thursday to repair a torn biceps tendon.

The biceps brachii muscle, or biceps as it is more commonly known, is one of the primary muscles of the arm. It attaches proximally (closer to the trunk) at the top of the shoulder and distally (further from the trunk) just below the elbow. The distal end inserts on the lateral forearm bone or radius (the outermost bone, on the thumb side), specifically on a bump called the radial tuberosity. The biceps flexes the elbow, as most people are aware, and anyone who has ever done resisted arm curls at the gym was no doubt trying to enhance their biceps bulk. What many might not realize is that the biceps also plays a critical role in turning the forearm palm up (supination). Injury to the distal biceps results in roughly a 30 percent strength deficit when flexing the elbow, but a 40 percent strength deficit for elbow supination. It is this potential persistent strength deficit in the arm that leads most athletes to have this injury surgically repaired -- after surgery, a return to full strength can be expected.

Rupture at the distal end of the biceps is not particularly common, and when it does happen, it usually happens to a middle-aged male while lifting something heavy. Brodeur's injury was that much more unusual because of how it happened; he tore his left distal biceps while extending his elbow quickly to make a glove save. As Brodeur told ESPN, "I just extended my arm real quick and I just felt a pop."

Martin Brodeur
Martin Brodeur will need to fully rehab before he is able to use his glove hand with his usual lethalness.

The good news is Brodeur is having surgery fairly quickly after the injury, giving the biceps minimal opportunity to scar down to other tissue. During surgery, the biceps will be reattached to the radius, and Brodeur's elbow will then be protected in a splint for a period of time. Brodeur will be gradually taken through increasing ranges of motion at the elbow, passively at first so as not to overload the tissue, then actively once sufficient healing has occurred. He will be progressed through a variety of strengthening exercises, then returned to sports-specific activities (in his case including manipulating a glove and a stick) and eased back into practice. He can maintain his conditioning on land initially, and will likely be cleared to skate within about two months (the concern initially, of course, is falling onto a still-healing arm and disrupting the repair). Interestingly, one of the more challenging skills for Brodeur to recover may well be the type of movement that led to his initial injury. The quick snap of the elbow into extension necessary to make a glove save requires full range of motion at the elbow, good strength at the biceps attachment and the ability of the tissue to adapt to speed. Brodeur will need to be able to do this before he returns to his spot in front of the net, and he must also prove that his elbow is prepared to withstand the contact that he can expect when forwards crash the crease.

These injuries do tend to heal well after surgery with diligent rehabilitation, and Brodeur should be able to resume his career without worry of future complications. The team's projected return time of three to four months is aggressive, but reasonable, barring any setbacks.

Stephania Bell is ESPN Fantasy's injury expert. She is a physical therapist who is a Board Certified Orthopedic Clinical Specialist and a Certified Strength and Conditioning Specialist.