Kyrie Irving left Sunday's game with what appears to be a shoulder injury, as detailed by The Cleveland Plain Dealer. The focus has been on his biceps tendon given Irving's reaction. The Cleveland Cavaliers will send Irving for imaging on Monday, but the fear along Lake Erie is that Irving has suffered yet another freak injury and will have his season cut short.
Irving headed back to Cleveland for an MRI which showed a strained biceps tendon. The biceps is one muscle with two heads, as you can see in this animation. The indication of two weeks, per ESPN, gives us the underlying diagnosis of a Grade I strain. This is the best possible news for the Cavaliers and for Irving in both the short and long term.
The mechanism of injury is apparent in this NBA video. Irving's arm is slapped while in full extension, exactly when the biceps would be tense and at highest risk. Luckily, while the tendon was put under stress, it did not significantly tear or split. There will be significant inflammation and point tenderness, but the injury should heal with rest and treatment.
Jeff Stotts, an Athletic Trainer that monitors injuries for Rotowire and has amassed an NBA injury database, said this about the injury:
I've watched the Kyrie Irving injury multiple times and the area of concern is clearly the proximal biceps near its origin in the shoulder.— Jeff Stotts (@RotowireATC) March 17, 2014
The biceps is a pretty well known piece of anatomy. The muscle of the anterior upper arm works to flex the elbow—the prototypical biceps curl—as well as allows the supination of the forearm. The classic example of this is using a corkscrew to open a bottle of wine. First, the biceps unscrews the top (supination) and then pull it out (flexion).
For an NBA guard, the motion is key. The biceps would be used to hold the ball in after a rebound, but the supination and control of the forearm would come into play on every dribble and pass. Trying to play without that sort of function, even at a reduced level, would be devastating and create problems in adjustment.
Given that the injury is at the glenohumeral joint, where the biceps is just one of the many structures involved in the articulation of the shoulder, it should be less problematic for Irving. The body can adjust due to the redundancy, though there is compromise and deficit. It could affect Irving's shot, if he has pain or weakness raising his arm, or could limit him defensively.
With only 15 games left on Cleveland's schedule, time becomes an issue. An injury that would take a month to recover from becomes "season ending," though the injury itself is no more serious and the recovery time is no longer. With a normal time frame for this kind of injury being seven to ten days, the Cavs are already being slightly conservative.
Stotts shared with me that this is a very uncommon injury in the NBA. The only comparable injury was to Jamaal Tinsley in 2006, though that biceps injury was on the elbow side, where it would affect the supination. Injuries like this are more common, though still rare, in overhead throwing sports.
I spoke with Ralph Reiff, the Hall of Fame Athletic Trainer who is now in charge of St. Vincent's Sports Performance in Indianapolis. His staff works with a number of world-class athletes and was instrumental in helping Greg Oden get back to the NBA. I asked him what he would do for a situation like Irving. He told me that the key would be the grade and location of the pathology.
"A tendon can be inflamed or strained. With the biceps, the tendon can be bifurcated or split in half and that can be a real problem," he explained. "With a low grade strain, the therapy will be relatively simple. He may need some stabilization or even a sling to keep it calmed down. Then you focus on reducing inflammation with different techniques or medications. You pull out some of the tricks of the trade, methods you feel good about like electric stimulation or some other things like that."
In the longer term, Reiff explained that the key is function and stability. As a known injury, the Cavs medical staff, which is well regarded, can regularly test it and work on strength and stability in the offseason. "Surgery or not, he'll have a lot of work to do. It's almost a full rehab regardless, if only to prevent a recurrence."
One complicating factor is that this is hardly Irving's first injury. Mary Schmitt Boyer notes his history:
Last year, he missed 11 games with a fractured left index finger, three with a hyperextended right knee and a total of nine after suffering a sprained left AC joint. He played through a broken bone in his jaw that was protected by a mask. Before last season, he broke his hand when he slapped a padded wall in frustration during a summer-league practice.
Irving's durability is one of the major questions about whether he can harness his talent and become one of the top stars in the NBA. This latest injury just adds to the concern and leaves the Cavs flailing toward the lottery once again.
While Irving avoided a serious injury this time, the Cavs will once again head into another offseason of rebuilding. If Kyrie Irving is the tentpole they expect to build around, they'll have to figure out how to keep him healthy.