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Triceps Tendon Injury
From WikiSM
Contents
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
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
- 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
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Last edited:
13 October 2022 13:30:39
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