Colts Safety Bob Sanders “The Hulk” is Sidelined with Elbow Injury

By Asheesh Bedi, MD

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As if the Colts secondary has not been tormented by enough injuries this season, we recently learned that strong safety Bob Sanders (“The Hulk”) will be out with a “distal biceps tendon rupture” at the elbow which will require season-ending surgery. The surgery was performed by the renowned orthopaedist Dr. James Andrews earlier this week. The biceps muscle is an important muscle in the upper arm. The distal tendon of the biceps muscle transmits all of the forces of the muscle to the forearm at its insertion (“radial or bicipital tuberosity”), thereby contributing to an athlete’s ability to forcefully flex the elbow as well as rotate their forearm in turning the palm upward (“supination”).

The distal biceps tendon can tear, preventing the transmission of forces from the muscle to the forearm bones. While it can happen from repetitive injury in athletes, it more commonly results from a single traumatic event in which the flexed elbow is resisted or even traumatically extended as in Sander’s case. The event is usually accompanied by a “popping sensation” and sense of sharp tearing around the elbow crease.

Once a distal biceps tendon is ruptured, it unfortunately will not heal on its own. Rather, the tendon will continue to retract away from the bone and slide up the arm as the muscle contracts without resistance. Over time, the tendon will be come stiff and scarred as well. This loss of biceps muscle function results in a loss of elbow flexion and forearm rotation strength (specifically turning the palm “upward”) in the arm. In elite contact athletes like Sanders, these injuries should be addressed acutely with surgical repair.

Usually the presentation of a distal biceps tendon is not subtle in the athlete. There will be the acute onset of a “tearing sensation” at the elbow, often accompanied by a “pop” when the tendon ruptures off the bone. When compared to the normal arm, the tendon can no longer be palpated at the elbow flexion crease. Frequently, there is swelling and bruising around the elbow flexion crease as well.

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