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Triceps Tendon Injury

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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

Differential Diagnosis

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
  • 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

References

  1. ↑ Foulk DM, Galloway MT. Partial triceps disruption: a case report. Sports Health 2011; 3:175–8.
  2. ↑ Donaldson, Oliver, et al. "Tendinopathies around the elbow part 2: medial elbow, distal biceps and triceps tendinopathies." Shoulder & elbow 6.1 (2014): 47-56.
  3. ↑ 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.
  4. ↑ 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:
13 October 2022 13:30:39
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