A dislocated left elbow sustained in the second week of the season, a major injury, has been only a minor hindrance for St. Louis' outside linebacker. After reinjuring the elbow in Sunday's victory over the Lions, he missed only a few plays.

Rams coach Scott Linehan said Tinoisamoa is "tough as nails."

"I'm not sure I've had a tougher kid than him," Linehan added.

When the brace needed to be adjusted, he waited impatiently before hitting the field with the elbow wrapped.

"You can't say enough about the kid," defensive coordinator Jim Haslett said. "You wish you had a handful like him."

Tinoisamoa has led the team in tackles each of his first three seasons after getting drafted in the second round out of the University of Hawai'i, although he enters Sunday's game at Green Bay sixth on a defense that has a number of major upgrades. He played much of the 2004 season in a shoulder brace after multiple dislocations didn't hold him back, either.

He missed three games in college with a broken leg, but came back to play the season finale. He just hates to watch.

"That's why I put all the pain aside," Tinoisamoa said. "For me to be off the field, I feel like I'm letting down my teammates. So whatever I have to do to get back in I'll do. Guaranteed."

Tinoisamoa said he tried to be patient when the brace needed work. But the calm never lasts.

"As each play passes I'm getting more and more antsy," Tinoisamoa said. "I heard them having trouble and I said, 'I've just got to go.' "

Besides the dislocation, the elbow has torn ligaments. He reinjured it trying to rise from the turf in a move akin to a push-up.

"I tried to brace myself and had too much weight on it," Tinoisamoa said. "Boom, it went out on me. But it's doing good."

Tinoisamoa, nicknamed "Hawaii-Five-O" after the popular TV crime drama based on the islands, refused to settle for getting through the game. Soon after returning, he got his first sack of the season.

"We've just got to figure out a way to minimize the pain when he does fall on it funny," Linehan said. "You'd never hear it from him."

Tinoisamoa credits his grandfather's strong bone structure and outdoor life on the islands that included climbing coconut trees.

"I keep pounding on it, but my body's done well," Tinoisamoa said. "I guess I'm built for this game."

Linehan said Tinoisamoa may have to wear the brace the entire season. Tinoisamoa has different ideas, hoping to shed it after the bye week following the Seahawks game Oct. 15.

He refuses to wear it off the field.

"People always ask me 'How's the elbow? I say, 'What elbow, what are you talking about?' "

Without trying, he's setting an example for the rest of the roster.