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Triceps Tendon Injury
From WikiSM
Other Names
- Triceps Tendinitis
- Triceps Tendonitis
- Triceps Tendinopathy
- Triceps Tendon Rupture
- Triceps Rupture
- Triceps Partial Tear
- Triceps Tear
- Triceps Tendinosis
Background
- Overuse tendinopathy of the distal insertion of the Triceps Brachii on the Olecranon process of the Ulna
- This page also serves to describe partial and complete triceps tendon ruptures
- Due to rarity, poorly studied and referenced in the literature
Epidemiology
- Most commonly occurs in men in their 40s
- Least common tendinopathy of the elbow (need citation)
Pathophysiology
- Tendinopathy occurs as a result of overuse or repetitive loading of the triceps tendon
- Partial ruptures appear to occur most commonly at the medial portion of the tendon[1]
- Triceps tendon rupture likely represents the terminal event of tendinopathy
- Rupture most commonly occurs at the osseotendinous junction (need citation)
- Rupture is associated with acute injury, with approximately half occuring from falls and half in bodybuilders performing bench press[2]
Pathoanatomy
- Triceps is primary extensor mechanism of the elbow
- Tendon thickens as it approaches elbow
Associated Conditions
Risk Factors
- Sports
- Throwing Athletes
- Overhead Athletes
- Chronic Kidney Disease
- Hyperparathyroidism
- Anabolic Steroids
Differential Diagnosis
- Fractures
- Adult
- Pediatric
- Dislocations & Instability
- Tendinopathies
- Bursopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Other
- Pediatric Considerations
- Little League Elbow
- Panners Disease (Avascular Necrosis of the Capitellum)
- Nursemaids Elbow (Radial Head Subluxation)
Clinical Features
- History
- Onset is typically insidious, although acute injuries can occur
- Patients report posterior elbow pain with active extension
- Physical: Physical Exam Elbow
- Patient will have tenderness along the olecranon
- Pain with resisted elbow extension often at 90° and 180°
- Distinguished from Posterior Elbow Impingement by reproducing pain with activation of triceps short of complete extension
- Special Tests (tendon rupture)
- Arm Bar Test: Arm is extended and pronated, apply a anteriorly directed force
- Triceps Squeeze Test: Army is abducted and internally rotated, hanging freely, squeeze distal triceps
Evaluation
Lateral elbow radiograph demonstrating olecranon enthesophyte
Axial cut of acute triceps tendon rupture on MRI
Sagittal cut of acute triceps tendon rupture on MRI
Radiographs
- Frequently normal, depending on duration of symptoms
- May demonstrate a spur emanating from the posterior olecranon
- Acute injuries may demonstrate an avulsion fragment
Ultrasound
- Can be used to evaluate for complete and partial thickness tears[3]
MRI
- Useful to evaluate for other etiologies of pain
Classification
- No classification system exists
- Important to distinguish between tendinopathy, partial tear and complete rupture
Management
- Very few publications to guide management strategies
- Most agree tendinopathies are non surgical, complete ruptures are surgical
- Little evidence to guide management of partial tendon tears
Nonoperative
Tendinopathy
- Indicated as first line approach
- Typically successful, however presence of a traction spur is associated with a higher failure rate
- Interventions
- Activity avoidance and relative rest
- NSAIDS
- Splint at 45°
- Consider Platelet Rich Plasma
- Consider
- Recommended to avoid
- Counterforce brace typically does not help (need citation)
- Corticosteroid Injection is contraindicated due to risk of rupture?? (need citation)
Partial Tears
- Case series of 10 NFL players managed conservatively, average of 5 weeks missed season[4]
- One patient: sustained a complete rupture within 6 weeks of his original injury requiring surgical repair.
- Six patients: successful conservative management with no residual loss of function or weakness.
- 3: underwent follow-up MRI showing a healed tendon.
- 3: underwent delayed surgical repair at the end of the season for continuing weakness and pain.
- All players returned to their previous level of sport for a minimum of one further season.
- Limited evidence to guide management
- Most case studies support initial conservative management
Operative
- Indications
- Failure of conservative management of tendinopathy after > 1 year of management
- Complete triceps tendon rupture
- Partial Tears
- Failure of conservative management
- Consider for tears >50-75% of tendon, however no consensus on this
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play
- Tendinopathies can likely return to sport when pain free
- Partial and complete tears
- Variable and at discretion of surgeon
- Surgically managed cases should anticipate a longer recovery period
Complications
- Loss of function
- Chronic pain
See Also
- Internal
- External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
References
- ↑ Foulk DM, Galloway MT. Partial triceps disruption: a case report. Sports Health 2011; 3:175–8.
- ↑ Donaldson, Oliver, et al. "Tendinopathies around the elbow part 2: medial elbow, distal biceps and triceps tendinopathies." Shoulder & elbow 6.1 (2014): 47-56.
- ↑ Tagliafico A, Gandolfo N, Michaud J, Perez MM, Palmieri F, Martinoli C. Ultrasound demonstration of distal triceps tendon tears. Eur J Radiol 2012; 81:1207–10.
- ↑ Mair SD, Isbell WM, Gill TJ, Schlegel TF, Hawkins RJ. Triceps tendon ruptures in professional football players. Am J Sports Med 2004; 32:431–4.
Created by:
John Kiel on 12 December 2019 22:00:31
Authors:
Last edited:
12 September 2023 17:15:22
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