triceps tear

Monday, October 23, 2017

When people take about the ironmen of sport, Cal Ripken’s name often heads the list, but it’s Joe Thomas of the Cleveland Browns who should be considered the ultimate sports warrior. As a lineman, there are never any plays off and each play is a battle against the largest players on the opposing team. Mr. Thomas’ streak of more than 10,000 consecutive players that began in 2007, has ended with a torn triceps muscle. It may be appropriate that to sideline this player, it required a triceps tendon rupture that is the rarest of tendon injuries.

The triceps muscle is located on the back (posterior) of the upper arm and is responsible for extending or straightening the elbow. It is balanced by the bicep, located on the front (anterior) of the arm, which flexes or bends the elbow. As its name implies, the triceps has three heads that arise from bones in the shoulder and join together to form the muscle. It then morphs into a tendon that crosses the elbow and attaches into the olecranon, the bony outcropping that can be felt at the back of the elbow joint.

It takes a lot of force to tear the muscle or pull the tendon off the bone and the mechanism is usually a fall on an outstretched arm with the muscle contracted, and there may or may not be a direct blow to the area. The arm collapses and the elbow hyperflexes, pulling on the triceps muscle that can’t protect itself. The injury causes either the muscle to tear in two,  pulls the tendon away from the bone or fractures the part of the olecranon where the tendon attaches. Regardless, the end result is an arm that the player cannot straighten and the diagnosis is pretty obvious to the trainer on the field.

While many athletic injuries have options for treatment, the complete disruption of the muscle, tendon or bone, needs an operation to reattach the pieces and put them where they belong.

The purpose of a muscle is to move a joint. It usually arises from a bony prominence on one side of a joint and then attaches via a tendon across the joint to another bone. When the muscle contracts, the joint moves. If the muscle tendon unit is torn completely (a third-degree strain), The ability to move the joint is lost. Without repair, power and range of motion may never return completely. Interestingly. Some third-degree tears can be treated without an operation with satisfactory results, but not in athletes or active people.

The concept of the operation is easy, but requires skill to prevent nerve or blood vessel damage. Rehab is measured in months returning range of motion is balanced against ripping the repair and having to start over. For that reason, physical therapy is an important part of returning to play. Elite athletes strain to test their repaired body parts too early and need to rein in their enthusiasm to do too much too quickly. Mother Nature and Father Time don’t like to be rushed.

All streaks must come to an end. Cal Ripken was able to orchestrate his last game but most athletes have their streaks ended without knowing when their last play might be. To be fair, that can be said for every athlete, regardless of age. Faster, higher, stronger pits performance against anatomy and physiology, and sometimes the body loses.

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