The Doctor Is In: Tuitt Likely To Miss 1 Or 2 Games After Biceps Injury


A mere 2 plays into the 2017 season, Pittsburgh Steelers DE Stephon Tuitt’s day was done.  Fresh off signing a contract extension worth $14 million guaranteed this season, the former 2nd round draft pick was looking forward to a monster season.  Instead, it looked like his season might be over…if you believe Adam Schefter.  A couple of twitter doctors (myself included) felt more optimistic, and I’ll explain why in a minute.

On the second play of the game, Tuitt dodged a TE with a blocking assignment to chase Browns RB Isaiah Crowell out of bounds, grabbing him with both arms but not actually tackling him.  As the defender slowed at the end of the play, he grabbed his upper right arm.  Tuitt didn’t report hearing a popping noise and described it as “my arm kind of went numb from just flicking it out a little bit.”

Here’s the play, and you can see that nothing all that dramatic occurs:

Trainers suspected a biceps injury and held him out for the rest of the game as a precaution.

After a night of dread, Steelers fans heard good news from defensive captain Cameron Heyward, who first tweeted “Fake news” and later claimed that the injury would not be season-ending.  This was confirmed by Coach Mike Tomlin at his weekly press conference today, describing the injury as “day-to-day” and said that it’s even possible that Tuitt could play this Sunday when the Steelers host the Vikings for their home opener.  The head coach acknowledged, of course, that it would depend on function, strength, and Tuitt’s ability to play effectively.

So what really happened to Tuitt and what does it mean for his recovery and return to play?  The team has referred to his injury as a biceps injury, which is a pretty vague term.  At his presser today, Tomlin added no detail.  Nothing has been said about the MRI results from Monday other than everything is “pretty good” and “better than it could have been”.  So as always, I will be doing a little educated speculation here.

BICEPS ANATOMY

The shoulder is a ball-and-socket joint, with the head of the humerus (the upper bone in the arm) sitting in a rounded space in the scapula (shoulder blade).  Several muscles and tendons keep those bones in the correct orientation both at rest and when moving.  These tissues form the rotator cuff.

The biceps muscle runs from the shoulder to the forearm just below the elbow.  The upper end has two heads, each with a tendon.  The long head attaches to the socket of the shoulder joint, and the short head attaches to the coracoid process (a bony prominence of the scapula).  The distal biceps tendon attaches near the elbow to the radius, one of the forearm bones.

(www.yoganatomy.com)

The biceps muscle helps to flex, or bend, the arm, as well as rotate it (supination, which is moving the arm from the palm up to the palm down position).

BICEPS INJURIES

Biceps tendon tears can be partial or complete (where the tendon is totally detached).

Proximal tears are much more common, and usually it is the long head of the biceps tendon that tears because it is more vulnerable as it passes through the shoulder joint.  Fortunately, the short head of the biceps tendon rarely tears.  And if one of the heads of the proximal biceps tendon remains intact, the biceps muscle can function to some degree and often with only a minor decrease in strength.

Distal biceps tears are far less common and are usually complete tears.

SYMPTOMS

With both proximal and distal tendon tears, a “pop” can sometimes be heard.  This would typically indicate a complete tear.  Sudden, sharp pain is the next thing a player might notice.  Bruising on the front of the arm, cramping of the biceps muscle with use, and weakness in the shoulder and elbow are also common, as well as difficulty turning the arm from palm up to down.

Visually, a deformity in the muscle can be seen with a complete tear.  If the proximal tendon is torn, the muscle mass is displaced further down the arm with a dent just below the shoulder where the muscle is no longer in position.  This is known as the “Popeye Muscle”:

(www.cambridgeshoulder.co.uk)

If the distal tendon is torn completely, the muscle retracts up the arm, forming a bulge closer to the shoulder:

(www.goudelis.gr)

TREATMENT

Initial treatment, like so many other orthopaedic injuries, includes ice, NSAIDs, rest, and physical therapy.  A tear of the long head of the biceps tendon often does not require surgery.  If pain or weakness persists, than a repair is recommended.  This can often be done arthroscopcially (small incisions and a telescope).  The goal is to anchor the tendon back onto the bone.  A distal biceps tendon rupture does require surgical repair.

SO WHAT ABOUT TUITT?!!!!

Let’s take a closer look, or as close as we can.  The cameras never showed the trainers working with Tuitt on the sideline, but thanks to Rich Walsh of KDKA, we have a video of Stephon welcoming his teammates into the locker room after their win over the Browns.  If you look at Tuitt’s left arm after he turns to his right side in the hallway, you can see that his bicep muscle looks normal and isn’t displaced proximally or distally.  Yeah, his arm is hanging at his side, but he isn’t wearing a brace or a sling.  In addition to that, one of the beat reporters commented that Tuitt was seen leaving the locker room holding his duffel bag with his left hand that day.  All of those factors suggest a lesser injury rather than one that would land a player on IR.

In addition to that, we have examples of NFL players, particularly defensive tackles and linebackers, that were able to return to play fairly soon after sustaining a biceps injury:

  • Ravens LB Terrell Suggs sustained a left biceps injury in 2012 and did not miss any games (I don’t even want to bring up how well their season turned out).
  • Terrell Suggs suffered a second left biceps tear in 2016 missing a game followed by a bye week, so he may have been back sooner if not for the bye week.
  • Dolphins LB Karlos Dansby played through the 2012 season with a torn biceps and did not miss any games (note: he played for Miami then; he is now with the Cardinals)
  • 49ers DE Ray McDonald played through a biceps injury sustained late in the 2013 season and underwent surgery in the off-season. He came back the next year and produced 27 tackles, 3 sacks, and 1 forced fumble.

Not all players can work through a biceps injury, of course.

  • Ravens 2013 1st round draft pick safety Matt Elam was lost for the 2015 season after a biceps tear. He’s a free agent at home on the couch now but not because of that injury.
  • After signing a 1-year “prove it” deal with the Packers, NT BJ Raji tore his biceps during a preseason game in 2014. He required surgery (most likely for a distal tendon tear) and missed the season.
  • The Steelers beloved DE Aaron Smith missed the last 4 games of the 2007 season due to a biceps injury (kind of ironic, this was after signing a 5-year contract extension in the off-season). It was suggested that this was a partial tear he was playing through which became a full tear.  The following year he produced 46 tackles, 6.5 sacks, and a Superbowl win J
  • Dolphins G Ted Larsen was placed on IR during this preseason with a biceps injury but is expected to be one of their “Designated to Return” players.
  • Falcons DE Adrian Clayborn missed the end of the team’s playoff run after injuring his biceps for the second time (the first was in 2014 with the Bucs). Both injuries landed him on IR but did not require surgery.

SPECULATION TIME

I know that Tomlin didn’t rule Tuitt out for the upcoming game against the Vikings, and with the performance of the Vikings offense on Monday night, the Steelers clearly need all hands on deck.  Obviously, his participation in practice will be the determining factor.  I still don’t think Tuitt will play this week.  Even if the tear is partial, it is better to allow the tissue to heal a bit before stressing it, particularly in a young player with a brand-new 5-year contract.

My guess is that we will see him back for week 3 against the Bears.  Either way, there is no doubt that Stephon Tuitt and the Pittsburgh Steelers dodged a bullet and are lucky that the injury wasn’t as bad as some NFL insiders predicted.

About the Author

Melanie Friedlander
Melanie Friedlander, MD, FACS, is a board-certified surgeon, who is a passionate Steelers fan and understands injuries from the player's side, too, thanks to four years of collegiate rugby.
  • WARisHELL

    Awesome stuff as usual, Melanie. I agree he’ll miss a 1-2 games and be back ready to rock.

  • Craig M

    Thank you for the in depth examination info, I only wish you could give such an excellent critique on our OC and his play strategy. 🙂

  • Talyn Scarbrough

    Let’s just keep him out a couple weeks. We have Alualu and he can hold down the fort until then. I really don’t wanna risk losing Tuitt for the postseason.

  • Guest12

    Punishment for Bell. Sitting him on the sideline is not as painful to him as being in the huddle and on the field but not getting the ball. Hints as why we ran so many screens. It looked like the few years right before we drafted Bell, run game wasn’t too strong so they used a lot of screen plays to supplement for the run game. Same thing they did on Sunday to punish Bell a little bit.

  • Kenneth Wilt

    Sit him until the Ravens game. Ravens on the road will not be an easy game.

  • newguy68

    Can we have more articles from Melanie ???????????????

  • pittfan

    Mel’s a great resource and vital addition to the SD team. I always like to wait till “The Doctor” weighs in before coming to any conclusions regarding injuries

  • AndreH

    Glad to here that its not a tear. Tuitt is a differences maker when he’s on the field.

  • ThatGuy

    Need more injury articles from Melanie. I always learn something valuable.

  • nikgreene

    Nice article. It’s funny that the Steelers missing one of the best D-Linemen for two games is ‘good’ news. Going into Sunday night I was sure he was gone for the season.

  • ThatGuy

    Me too, I was sick about it. Like another “here we go again” injury.

  • nikgreene

    Totally. It would have been almost comical – sign a 60M extension Saturday, play one defensive series Sunday, then go on season ending IR on Monday.

  • ThatGuy

    Agreed! On the flip side for those 2 plays he did look like a monster lol

  • Big White

    Great report Doc. We’ll take it!

  • Luneth Gardens

    How come no mention of the nerves, back, neck? The brachial plexus? He immediately felt some weakness but no real pain. Sounds like they should look at his cervical and upper thoracic spine and they probably did but will never go into that kind of detail with the media

  • srdan

    Mel, we appreciate you around here. Always well written and informed articles.

  • John Noh

    My IQ shot up 10 points by just reading this. So it’s like 60 now? Thank you for an in depth but palatable explanation of a complex subject matter.

  • Darth Blount 47

    A very nice, technical, and necessary article to read and have added to the usual fare on Steelers Depot. Good job, Melanie. That said… and please take ZERO offense… But I truly hope that your next article will be a puff-piece in January about how amazing it is that the Pittsburgh Steelers have gone from week 2 and on, without ANY injuries worthy enough to speak of. The only thing that can derail this train is a few horribly placed injuries. Every year, a couple of teams escape the year without any team-debilitating catastrophes. Just once, I’d love to see us be one of those truly lucky bunches. No suspensions and no heart/gut punches.

  • Joe Rea

    I want no more articles from Melanie. These are very informative and well written, however if no more injuries happen, she will not need to write any more. That is best case scenario. Since that will not happen in the NFL, I will appreciate the articles she writes.

  • RickM

    Melanie, who is always excellent, seems to be leaning towards a possible partial tear. But she wisely pointed out that Tomlin was vague in describing the injury. So I’m not sure any of us know the exact nature of the injury beyond the Steelers’ circle.

  • Joeybaggadonuts

    Doc, from a laymen…it seemed the injury wasn’t caused by anything explosive or the arm being torqued out of position. Could this be a result of a muscular imbalance with the opposing muscle group i.e. training Do you see this as ongoing or something that could be addressed to return to full functionality through the season?

  • jsteeler

    Wow, Accurate medical analysis on SD. I love it keep it coming.

  • Alex Kozora

    I would agree but that means more injuries. 🙁

  • NW86

    No offense to Melanie, but I hope not!! That would mean we are analyzing more Steelers injuries.

  • nutty32

    Some terrible blocking from TE Telfare & pulling LG Bitonio. Scheming the TE to man up on Tuitt seems doomed from the start.

  • americanpatriot

    depending on how the defense fares without him this week, I would (almost) hope he is kept out of the Bears game as well. Error on the side of caution. He is less likely to be needed for the Bears than for the Vikes. Backups need the work just in case the injury reoccurs. It’s a long season and maybe the most important in the last decade. Use the Bears prep to get him back on track and fully prepared for week 4.

  • Matt Manzo

    Thanks for the info, Doc! Steelers Nation sleeps a little easier tonight!

  • TroymanianDevil

    First, amazing article.

    We went from thinking he was gone for the season, to might play next week. I think we should play it safe. Don’t want it to linger throughout the season, or worse, actually tear it and be done for real. Depth is enough to absorb a few games without him. If he missed up to 4 games, I’d be confident in the teams ability to play without him. We need him for that touch stretch during the season and obviously the playoffs.

  • Wow, you guys are awesome! Thanks so much for all the nice comments. And I agree, I love writing for Depot but nothing would make me happier than if I had absolutely NO injuries to write about!

    I’ve thought about writing posts about key players on other AFCN teams from time to time. Wondering if that would be of interest to folks…

  • Sounds like whatever numbness Tuitt had cleared pretty quickly. He probably just tweaked one of the sensory nerves near the shoulder when he tore the tendon. A good physical exam by a trainer would be sufficient in that scenario, given that it was a minimal contact injury.

  • Great question. The incredible thing about a proximal biceps tendon injury is how little a movement it can sometimes take to tear. And it is probably an issue of wear and tear, particularly for a DE or OL, given the way they use their arms on every play. I don’t think this is the same type of muscle “imbalance” or “torque” that causes groin injuries in players with ripped quads and abs.

    I expect Tuitt to have a full recovery, but there will always be a small risk of recurrent injury.

  • Pghomer

    You do a great job and any insight beyond our ‘Groin Dr…Dr Dave’ lol would be welcomed. A better read than all of our speculation….

  • MC

    I forgot Aaron smith had such a nice season that late in his career.
    Man this injury was a major scare for me. I think we are gonna see a lot more of Tuitt ending up in the backfield like on the play he got injured. no need to rush back.

    If anyone wants to see biceps tearing, I somehow stumbled on horrific deadlift attempts in which this occurred on youtube, I don’t recommend however.

  • James Torrell

    Will he need surgery after the season is over?

  • Luneth Gardens

    So now he tore the tendon? Where is that report? In Tuitt’s own radio interview he said the MRI was good and there was nothing structurally wrong. In your article above you mention the visual, albeit non diagnostic, on KDKA that there was no displacement. So how did we go all the way to a torn tendon suddenly in your comment?

  • A “biceps injury”, which is what the team reported Tuitt has, is by definition a tendon tear of some sort. If it is only a partial tear, you won’t see any physical deformity. And I believe Tuitt’s words were: “So, since we got the MRI, we saw that everything was pretty good and we’re just going to strengthen it, get it back on, and then once I’m able to feel comfortable with that, we’ll be able to rock and roll.” I’m guessing pretty good means no significant injury that would result in surgery or a long absence from playing.

  • I doubt it.