Were You Told Your Triceps Tear Doesn't Need Surgery — Or That It's "Only a Partial Tear"?
There Is Another Option — and Another Interpretation.
Triceps tendon tears are among the most misunderstood injuries in orthopedic surgery. Patients are sometimes told their tear is "partial" and surgery isn't necessary. Others are told to wait and see. What many surgeons — and many radiology reports — miss is that what looks like a partial tear on MRI may actually be a complete rupture of two of the three triceps tendon heads, leaving only the deep head intact.
If you can still straighten your arm — but it feels weak — that doesn't mean your triceps is fine. It means your deep head is working overtime while the rest of your tendon has torn away from the bone.
Dr. Raffy Mirzayan reviews every MRI personally. He has published the largest series of triceps tendon repairs ever reported in the medical literature — 184 cases — in the American Journal of Sports Medicine (2018). If you've been told your tear doesn't need surgery, or if you've been offered a repair technique that carries a significantly higher risk of re-rupture, it is worth getting a second opinion from a surgeon who has seen more of these injuries than almost anyone in the country.
Call (310) 746-5918 to schedule a consultation. Virtual visits available for patients in Las Vegas, Phoenix, Scottsdale, and nationwide.
Understanding the Triceps Tendon
The triceps muscle is responsible for straightening (extending) the elbow. It is essential for nearly every pushing motion in daily life — getting up from a chair, pushing off a bed, pressing overhead, or extending the arm against resistance. Unlike the biceps, the triceps does not recoil dramatically when it tears, which is why the deformity is often subtle and the injury is frequently missed or underestimated.
The triceps actually has three tendon components:
- The superficial head and lateral head combine and insert together into the olecranon (the bony point of the elbow). These are the two heads that typically tear completely when a triceps avulsion occurs.
- The deep head is more muscular in character and typically does not tear along with the other two. Because it remains intact, patients often retain the ability to extend the elbow — but with notable weakness.
This anatomy has an important clinical implication: a radiology report reading "partial tear of the triceps tendon" may actually be describing a complete avulsion of two of the three heads. Many surgeons, seeing the words "partial tear," will not recommend surgery. Dr. Mirzayan reads every MRI himself — because the distinction between a true partial tear and a two-head avulsion changes the treatment entirely.
How Does a Triceps Tendon Tear Happen?
The most common mechanism is a backwards fall: the patient reaches behind them to break the fall, the elbow absorbs the impact in a partially bent position, and the eccentric force of bracing against the ground tears the tendon from the bone. Weight lifting — particularly heavy bench press — is the second most common cause.
Unlike many orthopedic injuries, triceps tears occur predominantly in middle-aged men. In Dr. Mirzayan's published series of 184 cases, 93% of patients were male, with a mean age of 49 years. Falls accounted for 56.5% of all tears; weight lifting and bench press for 19%; motorcycle accidents for another 9%.
Triceps tears are rare — they represent less than 1% of all tendon injuries — which is exactly why most surgeons have limited experience treating them.
Does a Triceps Tear Always Need Surgery?
Yes — in virtually all complete tears, and in most significant two-head avulsions, surgical repair is indicated.
The triceps is the primary force generator for elbow extension. Without it, everyday activities become difficult: pushing up from a chair, getting out of bed, reaching forward and pushing a door open. Unlike some tendon injuries where conservative management is a reasonable option, a complete or near-complete triceps avulsion does not heal reliably on its own, and chronic tears lead to progressive weakness and dysfunction.
The good news: the triceps tendon does not recoil the way a biceps tendon does after it tears. This means that even if surgery is delayed by several weeks — or even a couple of months — the tendon can typically still be repaired directly back to the bone without needing a graft. Dr. Mirzayan has successfully repaired triceps tears well beyond the traditional "3-week window" that some surgeons cite as the outer limit.
The Right Repair Technique Matters More Than You Think
Not all triceps repairs are the same — and the technique your surgeon uses has a measurable impact on your risk of re-rupture and reoperation.
The traditional repair method — used for decades and still taught in most residency programs — is called the transosseous suture technique: sutures are passed through the tendon and threaded through tunnels drilled in the bone, then tied over a bony bridge. It is the same basic concept used in patellar tendon repair, and most surgeons are comfortable with it.
Dr. Mirzayan's published data, however, tells a different story.
In his landmark 2018 study in the American Journal of Sports Medicine — the largest comparative study of triceps repair techniques ever published — he and his co-authors analyzed 184 triceps tendon repairs performed at 14 centers by 75 surgeons. The findings were striking:
- Re-rupture rate: 6.7% with transosseous repair vs. 0% with suture anchors (p = 0.024)
- Overall reoperation rate: 9.5% with transosseous repair vs. 1.4% with suture anchors (p = 0.026)
- Time to release from medical care: 4.3 months with transosseous repair vs. 3.4 months with suture anchors (p = 0.001)
Dr. Mirzayan uses suture anchor fixation for all of his triceps repairs — the technique the evidence supports.
He also routinely recommends elbow X-rays as part of the diagnostic workup. A lateral X-ray of the elbow can show what is known as a "flake sign" — a small sliver of bone avulsed from the olecranon along with the tendon — which is a reliable indicator of a true triceps avulsion in over 60% of cases. Recognizing this sign can reduce unnecessary MRI use and accelerate the path to appropriate care.
What to Expect from Surgery and Recovery
Triceps tendon repair is performed as an outpatient procedure under general or regional anesthesia. Dr. Mirzayan uses a posterior approach to the elbow, reattaching the avulsed tendon to the olecranon with suture anchors in a secure, anatomic configuration.
Recovery is progressive:
- Weeks 1–6: Protective splinting, gentle range-of-motion work begins
- Weeks 6–12: Active range of motion, progressive strengthening
- Months 3–6: Return to work and sport, depending on activity demands
- 6–12 months: Full recovery and strength normalization for most patients
Timing matters — earlier surgery generally means an easier repair — but unlike what some surgeons advise, repair is not foreclosed by a delay of several weeks. If you've been waiting because you weren't sure surgery was needed, or because you wanted a second opinion first, call Dr. Mirzayan's office. In most cases, direct repair is still possible.
Traveling for Triceps Repair — Why It's Worth It
Because triceps tendon tears are rare, most orthopedic surgeons see only a handful of these cases over the course of a career. The technique used, the judgment applied on the MRI, and the surgical precision of the anchor fixation all affect your outcome.
Dr. Mirzayan has performed these repairs extensively, published the definitive comparative study on repair techniques, and personally reviews every MRI to ensure the correct diagnosis and surgical plan.
For patients in Las Vegas, Henderson, Phoenix, and Scottsdale, a virtual consultation is available before you commit to traveling. Many patients with commercial insurance — Blue Cross Blue Shield PPO, Aetna, Cigna, United Healthcare — find that out-of-network benefits cover a substantial portion of surgical costs. Dr. Mirzayan's office will verify your benefits before your visit.
Call (310) 746-5918 or visit raffymirzayan.com to schedule a consultation — in person or virtual.
Frequently Asked Questions
Can I still straighten my arm after a triceps tear? Does that mean I don't need surgery?
Possibly — but it does not mean your tendon is intact. If your deep head is still attached, you may retain the ability to extend the elbow, but with significant weakness. Many patients with complete two-head avulsions can still straighten their arm against gravity. The key is whether that extension is strong enough for your daily demands. A thorough physical examination combined with a careful MRI review is the only way to know for certain. Dr. Mirzayan performs this evaluation himself.
My MRI report said "partial tear." Do I need surgery?
Not necessarily based on the report alone — but the report may be misleading. A finding of "partial tear" often reflects that the deep head is still intact, while the two primary heads have torn completely from the bone. Dr. Mirzayan reviews every MRI personally to distinguish between these scenarios, because the treatment is fundamentally different. If you have been told your tear is partial and surgery is not needed, a second opinion is reasonable.
How long can I wait before surgery is no longer possible?
There is no absolute cutoff. The traditional teaching is that surgery should be performed within three weeks, but Dr. Mirzayan's own published data show no difference in outcomes for repairs performed up to 12 weeks after injury. He has repaired triceps tears successfully even several months after the initial injury. The earlier, generally the easier — but don't assume the window has closed without speaking to a surgeon who has done this before.
What is the difference between a transosseous repair and a suture anchor repair?
Both techniques reattach the tendon to the olecranon. In transosseous repair, sutures are threaded through tunnels drilled in the bone. In anchor repair, small metal or bioabsorbable anchors are implanted directly into the bone, and sutures attached to the anchors secure the tendon. Dr. Mirzayan's published data — the largest comparative study in the literature — showed a significantly lower re-rupture rate, lower reoperation rate, and faster recovery with anchor fixation.
What is the recovery timeline?
Most patients return to light activities within six weeks and to full activity between four and six months, depending on the demands of their work or sport. Weightlifters and heavy laborers may take closer to six months to safely return to full loading. Dr. Mirzayan will give you a specific recovery plan based on your injury pattern and your goals.
I'm in Las Vegas / Phoenix / Scottsdale. Can I see Dr. Mirzayan?
Yes. Virtual consultations are available, and many patients from Arizona and Nevada travel to Los Angeles specifically for Dr. Mirzayan's expertise. Most commercial insurance plans include meaningful out-of-network benefits that significantly offset the cost of out-of-network surgery. Dr. Mirzayan's office will verify your coverage before your visit so you have a clear picture of costs before making any decisions.
Dr. Mirzayan's Published Research on Triceps Tendon Repair
Operative Management of Acute Triceps Tendon Ruptures: Review of 184 Cases Mirzayan R, Acevedo DC, Sodl JF, Yian EH, Navarro RA, Anakwenze O, Singh A. American Journal of Sports Medicine, 2018. The largest comparative study of triceps tendon repair techniques in the published literature, examining 184 repairs by 75 surgeons across 14 centers. Patients treated with suture anchor fixation had a significantly lower re-rupture rate (0% vs 6.7%), lower overall reoperation rate (1.4% vs 9.5%), and were released from medical care significantly sooner than those treated with the traditional transosseous technique. This study is the definitive evidence base for why Dr. Mirzayan uses suture anchor fixation for all triceps tendon repairs.
About Dr. Raffy Mirzayan, MD — Triceps Tendon Specialist in Los Angeles
Dr. Raffy Mirzayan, MD is a double-board certified orthopedic sports medicine surgeon at DOCS Health in Los Angeles, California. He is the author of the largest published series of triceps tendon repairs in the medical literature — 184 cases — establishing suture anchor fixation as the superior repair technique with a significantly lower re-rupture rate, lower reoperation rate, and faster recovery than the traditional transosseous method most surgeons still use today. With more than 10,000 surgeries performed over a 25-year career, he personally reviews every MRI to ensure an accurate diagnosis before any treatment decision is made. He has published 88 peer-reviewed papers in journals including the American Journal of Sports Medicine, Arthroscopy, JBJS, and JSES, and is a Clinical Professor of Orthopaedic Surgery at USC. Virtual consultations are available for patients in Las Vegas, Phoenix, Scottsdale, and nationwide — and with a triceps tear, the sooner you are evaluated by someone who truly understands this injury, the better your options.
DOCS Health | 8436 W 3rd St #800, Los Angeles, CA 90048 | (310) 746-5918 | raffymirzayan.com
