Triceps Tendon Injury
(Redirected from Triceps Tendon Rupture)
Other Names
- Triceps Tendinitis
- Triceps Tendonitis
- Triceps Tendinopathy
- Triceps Tendon Rupture
- Triceps Rupture
- Triceps Partial Tear
- Triceps Tear
- Triceps Tendinosis
- Posterior Tennis Elbow
Background
- This page refers to injuries of the Triceps Brachii including tendinopathies and tears/ruptures
History
- Triceps tendinopathies first discussed in the 1950s (need citation)
Epidemiology
- Most commonly occurs in men in their 40s
- Least common tendinopathy of the elbow (need citation)
Introduction
General
- 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
Etiology
- 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[3]
- 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[4]
Tendinitis
- Occurs as a consequence of resisted elbow extension activities
- Subsequently, traction occurs at the insertion on the olecranon
Anatomy of the Triceps Brachii
- Large, thick, 3 headed muscle of the posterior arm
- Primarily responsible for elbow extension, also supporting shoulder extension
- Origin
- Long Head: Infraglenoid tubercle of the Scapula
- Medial Head: Posterior surface of the Humerus (inferior to radial groove)
- Lateral Head: Posterior surface of the Humerus (superior to radial groove)
- Tendon thickens as it approaches elbow
- Insertion: Olecranon
Associated Conditions
Risk Factors
- Sports
- Throwing Athletes
- Overhead Athletes
- Occupation
- Heavy lifting/ activity/ labor
- Chronic Kidney Disease
- Hyperparathyroidism
- Anabolic Steroids
Differential Diagnosis
Differential Diagnosis Elbow Pain
- 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
- In complete ruptures, patients may not be able to extend the elbow at all
Physical: Physical Exam Elbow
- Patient will have tenderness along the olecranon and distal tendon
- 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
- Standard Radiographs Elbow
- Findings
- Frequently normal, depending on duration of symptoms
- May demonstrate a spur emanating from the posterior olecranon (enthesophyte)
- Acute injuries may demonstrate an avulsion fragment
Ultrasound
- Can be used to evaluate for complete and partial thickness tears[7]
MRI
- Useful to evaluate for other etiologies of pain
Classification
- Important to distinguish between tendinopathy, partial tear and complete rupture
Zacharia Classification for Tendon Avulsion Fractures
- Type 1
- Pain and swelling
- Not able to extend against gravity
- Palpable soft-tissue defect without bony mass
- Normal X-ray USG or MRI required for confirmation
- Type 2
- Clinical exam same as type 1
- XR: Wafer-thin or comminuted bony fragments
- Type 3
- Clinical exam same as type 1
- XR: Single large bony fragment/multiple large comminuted fragments not extending to the articular surface
- Type 4
- Clinical exam same as type 1
- XR: Single large bony fragment involving <25% of the articular surface in the X-ray/fracture line was within 1 cm from the tip of the olecranon
Management
General
- 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
- Often takes 3-6 months to achieve symptom resolution
- 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)
Nonoperative: Partial Tears
- Case series of 10 NFL players managed conservatively, average of 5 weeks missed season[9]
- 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
Prognosis and Complications
Prognosis
- Needs to be updated
Complications
- Loss of function
- Chronic pain
See Also
Internal
External
- Sports Med Review Elbow Pain: https://www.sportsmedreview.com/by-joint/elbow/
- https://mededcases.com/triceps-tendon-rupture/
References
- ↑ Malanga, Gerard, and Kenneth Mautner. Atlas of ultrasound-guided musculoskeletal injections. McGraw-Hill, 2014.
- ↑ Finlay, Karen, and Lawrence Friedman. "Common tendon and muscle injuries: upper extremities." Ultrasound Clinics 2.4 (2007): 577-594.
- ↑ 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.
- ↑ Bunshah, Jamshed Jal, et al. "Triceps tendon rupture: an uncommon orthopaedic condition." Case Reports 2015 (2015): bcr2014206446.
- ↑ Koplas, Monica C., Erika Schneider, and Murali Sundaram. "Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation." Skeletal radiology 40.5 (2011): 587-594.
- ↑ 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.
- ↑ Zacharia, Balaji, and Antony Roy. "A clinicoradiological classification and a treatment algorithm for traumatic triceps tendon avulsion in adults." Chinese Journal of Traumatology 24.05 (2021): 266-272.
- ↑ 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:
14 August 2025 15:57:33
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