Triceps tendon tears generally occur in middle aged men after forceful elbow eccentric extension. Triceps tendon rupture is more frequent in those between 30 and 50 years of age, and is twice as frequent in males. In general, tears of >50% of the tendon insertion are treated surgically. Various repair methods have been described in the literature with the aim of restoring the normal tendon footprint insertion.
The triceps muscle, as indicated by its name, includes three heads. The long head originates from the scapula, while the medial and lateral heads originate from the humerus. These three heads join together at elbow level and attach to the olecranon to form one of the strongest tendons in the body.
Triceps tendon rupture results from overloading on the extended elbow, or an abrupt contraction of the muscle. The most frequent mechanism in the literature is a fall on the hand with the elbow in extension. Weightlifting is a high-risk athletic activity for triceps rupture.
Patients often describe a pop at the back of the elbow. Swelling and bruising are frequently seen at the back of the elbow. A gap can be felt at the tip of the forearm bone where the tendon inserts. Although a significant reduction in extension strength is normally present, complete loss of active extension is seen in only 20% of cases.
Xrays are often normal although there can be a fleck of bone where a small avulsion occurs with the tendon off the bone. MRI is diagnostic for a rupture showing detachment of the tendon from the bone.
Most complete triceps tendon ruptures require repair otherwise there will be a significant loss of extension strength. Full tears should be repaired within 2 to 3 weeks of injury otherwise these may need to be augmented with a graft to obtain a complete repair. Partial tears less than 50% of the width of the insertion may be considered for nonoperative treatment although over 50% of these patients will fail nonoperative treatment due to persistent pain and weakness and go on to surgical repair.
Surgery is performed typically in an outpatient setting.
Postoperatively patients are treated with a nerve block for pain control. They are splinted for a week and then placed into a functional brace. The goal is to have full motion by weeks. At 8-12 weeks postoperative, strengthening is started with plans for full return to activity by 6 months postoperative. Recovery is expected to be complete with full return of strength and sporting activities including weight lifting.