Oakland Raiders

Comparing Jared Veldheer's Triceps Injury to Ray Lewis', Justin Smith's

DENVER - OCTOBER 24:  Center Jared Veldheer #68 of the Oakland Raiders celebrates a touchdown by teammate Darren McFadden (not pictured) in the third quarter against the Denver Broncos at INVESCO Field at Mile High on October 24, 2010 in Denver, Colorado. The Raiders defeated the Broncos 59-14. (Photo by Justin Edmonds/Getty Images)
Justin Edmonds/Getty Images
Dave Siebert, M.D.Featured ColumnistAugust 15, 2013

For a brief period on Wednesday, many Oakland Raiders fans resigned themselves to the fact that their star offensive tackle Jared Veldheer would likely miss the entire season with a torn triceps. The official Raiders Twitter account broke the news.

Later, ESPN's Adam Schefter reported that Veldheer sustained a partial triceps tear rather than a complete one.

How much does the difference between a partial and complete tear matter?

In short: A whole heck of a lot. As Schefter tweeted, it might even save a good portion of Veldheer's season.

Why is that the case?

Let's take a closer look, using San Francisco 49ers defensive end Justin Smith and former Baltimore Ravens linebacker Ray Lewis as comparable versions of a similar injury.

 

What Is the Triceps?

Perhaps this is too simple of a question, but it helps to start off with some basic anatomy and build from there.

Simply put, the triceps is a group of three muscle bodies responsible for elbow extension—or straightening the arm.

One of the three triceps muscle bodies originates from the shoulder blade, while the other two start at the back of the humerus—or upper arm bone. The three bodies then run down the back of the upper arm before joining into one muscle tendon that attaches to the olecranon—the part of the elbow used to lean on a tabletop.

When the triceps contracts, its tendon pulls on the olecranon in the direction of the upper arm and shoulder, thereby straightening the elbow. From a football standpoint, a strong triceps is especially crucial for offensive and defensive linemen, as players at these positions use it to push away or off of opposing players.

However, certain scenarios can overstress the triceps tendon and cause injury. That's where Jared Veldheer comes in.

 

What Causes Triceps Injuries?

Ligament and tendon tears usually occur when an outside force counteracts and overwhelms the natural function of the tissue in question. In the case of the triceps, forced bending of the elbow is to blame, and linemen are especially vulnerable.

To better visualize the circumstances surrounding a triceps injury in football, imagine the following scenario:

  1. An offensive lineman engages a pass-rusher.
  2. The offensive lineman fully contracts his triceps in attempt to push the pass-rusher back.
  3. A second defender is pushed into or hits the inside of the offensive lineman's elbow, sharply bending the arm—and therefore stretching the tight, contracted triceps.

If the hit is strong enough, the concurrent-but-opposing force tears the tendon partially or completely off the olecranon. Though exact details are not available, speculation suggests Veldheer likely went down due to a similar sequence of events.

 

What's the Difference Between a Partial and Complete Triceps Tear?

Though it sounds obvious, following a partial tear, the triceps tendon remains partially attached to the bone. During a complete tear—sometimes called an avulsion—the tendon separates entirely from the bone and retracts upward into the arm. Often, patients and doctors can feel a gap just above the back of the elbow where the tendon once stood.

Athlete functionality and recovery time following a partial tear differs greatly from that of a complete one as well.

First off, since the tendon remains partially attached to the olecranon after an incomplete injury, straightening of the elbow is still possible. However, the action is much weaker than normal—not what a team wants in an offensive lineman who is trying to push back defenders following each and every offensive snap.

Conversely, after a complete tear, elbow extension is essentially impossible. Complete tendon ruptures also do not heal on their own. Instead, surgeons must operate in order to directly visualize the tendon and re-attach it to the olecranon.

On the other hand, the necessity of surgery to repair partial tears is controversial.

That said, partially torn muscle tendons may not heal well owing to their relatively poor blood supplies when compared to other tissues. What's more, when it comes to NFL players, any decreased strength is too much. As such, Veldheer and his physicians understandably elected to proceed with surgery.

 

Did Justin Smith Take Risks by Playing with a Partially Torn Triceps Last Year?

At the end of the 2012 season, Smith played through the Super Bowl with what he called a 50 percent tear of his triceps tendon.

At least.

Why did he choose to do so?

The answer—just like all sports medicine decisions—comes down to risk versus reward.

First, the 49ers were eyeing the Super Bowl at the time of his injury. Perhaps more important, Smith already proved his worth when Russell Wilson and the Seattle Seahawks offense dismantled the Smith-less 49ers by a score of 42-13.

In other words, when it came to the playoffs, a hobbled Smith was better than no Smith at all.

However, make no mistake: Smith took a risk on every snap, as injured tendons are weaker tendons and therefore less able to resist further injury. Luckily, he made it through unscathed, only to undergo surgery soon after the season ended to ensure definitive healing.

 

Can Veldheer Return this Season Like Ray Lewis Did?

The short answer? Almost definitely.

Ray Lewis tore his triceps in mid-October of last year. While complete tears often require up to six months of rehab following surgery, the Ravens linebacker returned from his in time for the playoffs—about two-and-a-half months of recovery time.

Similarly, initial reports gauged Justin Smith's required rehab time following his Feb. 2013 surgery at about three months. By mid-April, he was already in the weight room, though, as mentioned, his injury was of the partial variety.

If the precedents set by Lewis and Smith aren't enough, Veldheer might already have a leg up on the two. According to Schefter, the Raiders left tackle's injury is a "lesser version" of Lewis' and Smith's.

As always, it is important to keep in mind that setbacks are possible, and diagnoses released to the public do not always accurately reflect what is really going on.

Nevertheless, if all media reports are true, and if his projected recovery speeds along similar to Lewis and Smith—a gigantic assumption in and of itself—Veldheer could set foot on the field as early as November. According to Brian McIntyre of Yahoo! Sports, he is eligible to come off injured reserve after Week 8.

Whether or not the Raiders want to risk re-activating their young star during what could turn into a tough season, however, remains to be seen.

 

Dr. Dave is a resident physician at the University of Washington with plans to pursue fellowship training in Primary Care Sports Medicine. Medical information discussed above is based on his own knowledge.

Follow @DaveMSiebert

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