As soon as Bertrand Berry saw the replay of Ray Lewis's final tackle last Sunday — made with Lewis's left arm, as his right hung at his side — he knew exactly what was wrong.
"When he did it, I said, 'Oh, no,' " Berry, a former Arizona Cardinals defensive end, said in a telephone interview this week. "I could tell the way he was holding his arm; it was a very awkward angle he was holding it. Your lower arm, from the forearm down, you can't make it go where you want it to go. Your arm is just flailing around."
Berry knew from experience. He, like Lewis, the Ravens linebacker, had torn his triceps — Berry did it in both arms, almost exactly a year apart. The injury is very rare in the general population and even among most athletes, but it is a bit more commonplace among those whose job it is to shove very large people out of the way.
Denver defensive lineman Ty Warren has missed most of the last two seasons with two separate triceps tears. A teammate, defensive lineman Jason Hunter, tore his triceps during the preseason, as did Arizona offensive tackle Levi Brown and Tennessee center Eugene Amano. The now-retired center Kevin Mawae's streak of 177 starts was ended in 2005 by a torn triceps.
Still, sports medicine specialists who have performed thousands of operations to fix the ubiquitous anterior cruciate ligament tears in professional athletes and in weekend warriors can count on two hands the number of triceps they have stitched up. The injury usually happens when a person is trying to push someone or something away and there is a sharp force to the bend of the elbow. In Mawae's case, the mammoth Buffalo defensive lineman Sam Adams fell on his elbow. Tony Danza, the actor, tore his triceps when he fell while rollerblading with video camera in hand through "The Gates," Christo and Jeanne-Claude's art installation in Central Park in 2005. Older people occasionally tear them when they fall.
Warren wondered if the wear and tear of playing a two-gap defense in New England, where he was on the field for many snaps during games, contributed to his injuries. Berry speculated that dehydration and perhaps diminished testosterone levels caused by grueling practices contributed to an injury that he called trendy among linemen. Doctors say steroid use and repeated cortisone injections in the elbow may weaken the tendons.
While the biceps muscle is responsible for bending the elbow, the triceps muscle's main job is to extend to make the elbow straight. The tendon attaches at the tip of the elbow, and the force of a collision or a fall causes the tendon to tear off the bone. The back of the arm usually swells, and the arm gets weak. Sometimes doctors and trainers can feel through the skin the void created where the tendon has detached from the bone. Even for the strongest, most well-conditioned athletes like Lewis, it is difficult to extend the arm against the slightest resistance.
"Biceps tear much more frequently," said Jonathan Glashow, an orthopedic surgeon and the co-chairman of sports medicine at New York's Mount Sinai Medical Center. "This is a flat, broad tendon — the force is spread over a bigger area. You don't do abrupt things with your elbow unless you're pushing someone or you fall on it."
Once the triceps tears, it is hard to miss. Berry recalled that he heard his triceps snap both times. Warren lost strength in his arms in the middle of the plays on which he was injured. The area around the elbow felt as if it were burning, as if someone were rubbing an eraser on the skin over and over.
On the field, the impact is immediate — players can no longer push off — but it is in life's mundane tasks that the triceps is most appreciated. Reaching up to change a light bulb or to put something on a shelf would be difficult with a torn triceps. It is nearly impossible to push up out of a chair, a reason surgery is almost always recommended in older patients. Warren had to push his chair back from a table whenever he had to write because he could not bend his arm the way he wanted to. Danza was said to have joked that he could not pick his nose.
"Signing a check? Good luck," the right-handed Berry said of tearing his right triceps. "Brushing your teeth. You don't think of the little things you do."
The metal brace Berry had to wear after surgery made getting through airport security difficult. Driving was no better. The brace was so heavy that his arm ached from having to be held high enough to steer. It was so annoying that when Berry ripped his left triceps a year later, he was grateful that it, at least, was not his right one again.
The Ravens said that Lewis's tear was complete. Surgery is a must in those cases; sometimes nonathletes can try to rehabilitate partial tears without surgery. The good news is that the surgery is fairly straightforward.
According to Gautam Yagnik, the chief of orthopedic surgery at West Kendall Baptist Hospital in Miami-Dade County, Fla., and a specialist in sports medicine, an incision is made in the back of the arm. Holes are usually drilled in the bone at the end of the elbow and, after the end of the torn tendon is identified, sutures are sewed through it. Then doctors sew the torn tendon back down to the bone. There are no fancy screws, and very rarely is a cadaver tendon needed when surgery is performed soon after the injury.
The bad news?
"Of the ones that were repaired, they generally missed a whole season to come back, but most were able to come back and play," Yagnik said. "It's not necessarily a career-ending injury, though."
Lewis had surgery Wednesday, and the Ravens put him on injured reserve with the designation that he could return this season. That seems like wishful thinking even if the Ravens make the Super Bowl because, Glashow said, a tendon is not fully healed for three months. That does not include the time it would take Lewis to regain the normal strength in his arm. Berry and Warren both said it took them about six months. Lewis, 37, has made no announcement about his plans since the injury, but Glashow has one bit of encouragement to offer.
"It's a lot better to have this," he said, "than A.C.L.'s."
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