Tears of the triceps tendon tend to occur with sudden deceleration injuries, such as breaking a fall with an outstretched elbow or during competitive sports such as football or martial arts.
The triceps is composed of three heads: lateral, long and medial. It originates on the lateral intermuscular septum of the humerus (lateral), the infraglenoid tuberosity (long) and the posterior humerus (medial). The insertion of the triceps occurs over a broad footprint on the distal tip of the olecranon (ulna). The triceps is innervated by the radial nerve (C6-C8).
Tears are classified by degree (complete, partial or intact) and location (avulsion, tendon insertion, musculotendinous junction or muscle belly).
Pain, swelling and local bruising occurs at the tear site. Weakness may be present depending on the extent of tear.
On exam, there is often tenderness to palpation in the area of injury. Clinicians also assess for a palpable defect where the tendon should insert. Range of motion of the elbow may be restricted due to the swelling. Laxity of the elbow joint can be tested with a hands-on examination.
X-rays are performed to rule out a fracture or avulsion injury of the tendon from the olecranon. MRI may be ordered to assess the integrity of the triceps muscle and tendon, and to determine specific injury location and severity.
The majority of triceps sprains are managed without surgery. Initial management includes rest, elevation, immobilization/protection of the injury and anti-inflammatories. Physical therapy is incorporated to aid the return to full, desired activities. Physical therapy focuses on restoration of motion, reduction in pain, advancement of activities and return of proprioception/balance.
Primary surgical triceps repair may be indicated in acute, complete tears or partial tears with significant weakness. If the injury is chronic, reconstruction with a graft may be needed. Following surgery, a period of post-operative immobilization follows, along with a guided course of physical therapy.