Do I Really Need My Biceps Tendon?

Brett Favre just had one detached, and he can still play football …

How can Brett Favre play ball with a dangling tendon?

The Minnesota Vikings are anxiously waiting to hear whether quarterback Brett Favre will join the team this season or stay retired. This summer, the future hall-of-famer had his damaged right biceps tendon surgically detached, though reports suggest the procedure will not affect his ability to throw. Wait, don’t we need our tendons for something?

Yes, but some tendons are more important than others. Tendons serve a vital role by attaching muscle to bone. That said, a tenotomy—the surgical cutting of a tendon—is sometimes used to treat jumper’s knee, club foot, hammertoe, trigger finger, and certain congenital ocular disorders. In most cases, the tendon is either partially severed or  cut through and then reattached somewhere nearby. For Favre, the procedure was used to treat an inflamed long-head biceps tendon, which connects one side of the Y-shaped muscle to the scapula. Surgeons were able to sever the tendon without reattaching it because the muscle was still connected to the shoulder via the short-head tendon.

It’s no surprise that Favre’s biceps tendon was a little frayed. Over the course of his professional career he’s whipped a one-pound football over his head 9,280 times (and that’s not including decades of practice sessions). Under normal circumstances, the first-choice treatment for this condition would be rest and rehab. Another option would be to detach the tendon and reattach it to the humerus—the bone that connects the elbow to the shoulder. The fact that Favre declined these two options—both of which involve months of recovery time—suggests that he’s itching to play ball this season. By having his doctors snip the damaged tendon and leave it hanging down into the upper arm, Favre has chosen the quickest way to relieve his pain.

A biceps can still function with a detached long-head tendon. Football players have taken a hit that detached the tendon and returned to play in the same game. Plus, the biceps is far from the most important muscle for a quarterback. The majority of the force in a football throw comes from the pectoralis major, the latissimmus dorsi, and the rotator cuff and the quadriceps and glutes. The biceps doesn’t really spring into action until after the ball is released, and even then it works at only about 20 percent of full capacity.

Will Favre lose some strength or be forced to change his mechanics? No one can say for sure. While studies have shown that the average patient does not suffer significant loss of mobility from the procedure, even minimal impairment might be problematic for a professional athlete. There is a chance that Favre will suffer from the so-called “popeye” deformity, in which the tendon dangles into the upper arm and gives the appearance of a perpetually bulging biceps. An inflamed biceps tendon can also indicate bigger problems, like an injured rotator cuff requiring more drastic intervention. Favre won’t know whether the tenotomy has solved his problem until he spends some time throwing.

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Explainer thanks Larry Lemak of Lemak Sports Medicine.