Outlook for Justin Smith Following Surgical Repair of Partially Torn Triceps

Dave Siebert, M.D.Featured ColumnistFebruary 5, 2013

NEW ORLEANS, LA - JANUARY 29:  Justin Smith #94 of the San Francisco 49ers answers questions from the media during Super Bowl XLVII Media Day ahead of Super Bowl XLVII at the Mercedes-Benz Superdome on January 29, 2013 in New Orleans, Louisiana. The San Francisco 49ers will take on the Baltimore Ravens on February 3, 2013 at the Mercedes-Benz Superdome.  (Photo by Chris Graythen/Getty Images)
Chris Graythen/Getty Images

That sound you hear is the collective exhale of the three muscle bodies that make up San Fransisco 49ers defensive end Justin Smith's formerly partially torn left triceps.

After playing through an approximate 50 percent tear of his triceps tendon throughout the playoffs and Super Bowl, Justin Smith underwent surgical repair of the injury during the week following the big game (h/t Matt Maiocco of Comcast Sports Net).

Smith likely played through significant pain and weakness since originally suffering the injury in December. He also risked further injury—such as a complete tendon rupture—every down he played. However, given that he is an instrumental part of the 49ers defense and that his team advanced all the way to the Super Bowl, Smith decided to take that risk.

Thanks to the protective brace he wore and a little bit of good luck, his triceps made it to the off season still partially intact. Yet make no mistake—every time Smith used his triceps to push off an offensive linemen or tackle a runner, he stressed the already-weakened muscle. Additionally, if a hit to the inside of his elbow forced it to bend at the same time as he pushed off, more damage could have been done.

The precise location of the injury complicated matters further, as well. Muscle tendons—the tough part of the muscle that attaches the bulk of the muscle body to the bone—have relatively low blood supplies when compared to tissues such as the skin, limiting their self-healing ability.

That is where surgery comes in, as it allows for both direct repair and a much more predictable healing time, as discussed by Dr. David Chang (h/t Eric Branch, SFGate.com).

Surgical repair of a partially triceps tendon usually involves stitching whatever parts of the tendon that have detached from the olecranon—part of the ulna and also the portion of the elbow used to lean on a table—through small holes drilled in the bone.

After a period of healing following surgery, Smith will begin rehabilitation.

Rehabilitation will likely consist of a slow, stepwise progression through exercises of increasing intensity designed to slowly work the repaired triceps tendon back into place—it needs time to cement itself onto the bone, so to speak. Smith's rehab might look something like the following, each step requiring anywhere between a few weeks to months depending on progress:

  • Simple range-of-motion exercises—ensuring he is able to fully straighten his arm against no resistance without pain or difficulty
  • Strength training exercises—ensuring he can extend his arm against steadily-increasing amounts of resistance or weight
  • Functional training—ensuring he can push off offensive lineman, push down running backs and perform other tasks crucial for him to be effective on the football field

The gradual increase in complexity and required strength—likely requiring upwards of three months—allows Smith to rehabilitate his muscle with minimal risk of re-injury.

For example, if he were to try to push off an offensive lineman immediately following surgery—while the tendon is still very weak and healing—he could easily rip the tendon off the bone yet again. To ensure that does not happen, physical therapists will evaluate his arm's capabilities at each level of training before progressing onwards.

According to Maiocco's report, Smith is expected to progress through the rehab protocol without difficulty and should make a full recovery. That is spectacular news for Smith and the 49ers, as triceps tears can be tricky.

At present, there exists no universally accepted way to treat partial triceps tendon tears, as reviewed here by Dr. David M. Foulk and Dr. Marc T. Galloway of the Cincinnati SportsMedicine and Orthopaedic Center in Cincinnati, Ohio (h/t NCBI.nlm.nih.gov). 

While complete tendon avulsions require surgery without exception, the decision to undergo surgical repair of partial tears is a decision based on a patient's unique circumstances and discussions with his or her physician. However, in a professional athlete, surgical repair is often recommended in order to ensure tendon reattachment—their livelihoods depend on it.

For now, expect to see Smith ready for next season barring any setbacks. After his value became so obviously known to 49ers fans during a Week 16 blowout at the hands of the Seattle Seahawks, a fully-recovered Smith will be vital to a repeat Super Bowl run.


Dave Siebert is a medical/injury Featured Columnist for Bleacher Report who will graduate medical school in June. He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine. Information discussed above is based on his own knowledge and experience evaluating injuries and shadowing physical therapists.