The triceps is a muscle on the back of the upper arm that straightens and stabilizes the elbow. You can envision what the triceps does by doing a triceps kickback exercise.
As the name suggests, the triceps has three muscle bodies, or “heads”: the long head comes from the shoulder blade (scapula), while the lateral and medial heads come from the upper arm bone (humerus). These three components of the triceps eventually merge into a tendon that attaches further down the arm, onto the bony prominence of the elbow (olecranon).
A distal triceps tear occurs when the tendon (which connects the muscle to the bone) starts to detach from the bone at or near the elbow. A tear (also known as a rupture) can be complete or partial.
Tears are rare in the general population under the age of 60, as they only occur with substantial force. Even without experiencing a specific injury, older patients may develop difficulty using their arm to push themselves out of a chair. This can be associated with a partial or full-thickness tear.
“A distal triceps tear occurs when the tendon starts to detach from the bone at or near the elbow.”
Symptoms
Symptoms of a triceps tendon tear include:
- Sharp pain when straightening or bending the elbow
- Pain, swelling, and bruising near the elbow
- A “popping” noise at the time of injury
- A large bulge in the posterior aspect of the arm
- Difficulty using your arm to push out of a chair
A complete triceps tear can affect many aspects of a person’s life because they cannot push themselves up with their arms (getting out of chair, bed, or couch).
Causes
Distal triceps tendon tears typically occur after a sports injury or a traumatic fall on an outstretched hand. Sports frequently associated with this injury are weightlifting (e.g., French arm curl and weighted triceps dips), and contact sports like football.
Risk conditions include:
- An underlying medical condition (such as rheumatoid arthritis)
- The use of anabolic steroids
- The use of fluoroquinolone antibiotics (such as ciprofloxacin or levofloxacin)
- Previous elbow surgeries
Diagnosis
Triceps tears are diagnosed by a medical provider based on the person’s history of injury, physical examination, X-rays, and MRI scans.
Nonsurgical treatment options
Every triceps tear is different. Some are small or chronic in nature and can be treated nonsurgically with rest, ice, splinting, bracing, and physical therapy.
Larger or complete tears that cause disability in daily activities may require surgical repair or reconstruction. In most cases, a triceps tear will require surgery to restore the arm's normal function.
How surgery is performed
If surgery is recommended, it should ideally be done relatively soon (i.e., within a month of the injury). If the injury is not treated promptly, the tendon and muscle can scar and shorten over time, making it harder to repair. If it’s not possible to bring the tendon back down to bone due to shortening, an allograft tendon will be necessary to reconstruct the triceps.
Surgery involves making a cut on the back of the arm near the elbow and locating the torn ends of the tendon. Thick stitches (sutures) are sewn through the end of the tendon that is attached to the triceps muscle. Then, the surgeon drills tunnels into the bony prominence (olecranon) of the elbow. The stitches are passed through these bony tunnels to bring the torn end of the tendon back to the bone. Additionally, bone anchors improve the strength of the fixation to bone.
“Complications are rare following a distal triceps tear repair.”
Recovery time
After surgery, the arm is immobilized in a hinged elbow brace for approximately four weeks to protect it. During those four weeks, we gradually increase the amount of elbow extension allowed while being protected in the brace. This helps regain range of motion while protecting the repaired tendon.
During the recovery period, pain medication can be taken to alleviate discomfort. Some patients may require help to eat, bathe, and dress since they cannot use the affected arm.
Physical therapy is recommended as part of the recovery plan to regain elbow motion and strength.
Results
The recovery from triceps tendon repair depends on the nature and severity of the initial injury as well as the person’s health and age.
Athletes who have had a triceps tendon repair may generally initiate weightlifting exercises after three months. By six months, they will have 80% or more of their distal triceps strength. It may take up to one year before they can establish similar strength that was present before the injury. Not all weightlifters regain equal strength to what they were capable of before surgery.
FAQs
Are there any risks associated with distal triceps tear repairs?
Complications are rare following a distal triceps tendon repair. With complete distal triceps tendon tears, the ulnar nerve will be exposed on the inside aspect of the surgical site. It's important that the nerve is identified and protected during the surgical repair so that it is not damaged. In older patients and those with inflammatory arthrities, there is potential for wound infections due to the thin tissues at the tendon insertion site.
For more information about repairing a torn triceps tendon, please request an appointment with experienced Chicago orthopaedic surgeon Dr. Anthony Romeo. Call or email our office today to schedule your visit.
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