Distal Triceps Tendon Rupture

Aka: Distal Triceps Tendon Rupture, Triceps Tendon Tear, Triceps Tendon Rupture

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II. Epidemiology

  1. Uncommon injury (1-2% of all tendon injuries)
  2. More common in middle aged men

III. Mechanism

  1. Falling on an outstretched hand
  2. Forceful eccentric triceps contraction
    1. Contracted triceps is forced to lengthen in elbow extension
  3. Direct elbow Trauma
  4. Lifting against resistance

IV. Risk Factors

  1. Sports
    1. Football
    2. Weightlifting
  2. Rheumatologic Disorders
    1. Rheumatoid Arthritis
    2. Osteogenesis imperfecta
    3. Renal Osteodystrophy
      1. Secondary Hyperparathyroidism in Chronic Kidney Disease Stage 5
  3. Miscellaneous disorders
    1. Tetany due to Hypocalcemia
    2. Anabolic Steroid use
    3. Diabetes Mellitus

V. Symptoms

  1. Painful popping Sensation at the Posterior Elbow

VI. Signs

  1. Painful and weak active elbow extension

VII. Imaging

  1. Elbow XRay
    1. Initial study to exclude other injury causes (e.g. Fracture, dislocation)
    2. Flake sign of avulsion Fracture at the olecranon may be present in Triceps Tendon Tear
  2. Ultrasound
    1. High frequency linear probe may demonstrate a gap in the tendon as it inserts on the olecranon
    2. Tendon defects may be better seen when the elbow is gently flexed and extended during Ultrasound
  3. CT Elbow
    1. Identifies other injuries (e.g. occult Fractures)
    2. May demonstrate avulsion Fracture at the triceps tendon insertion on the olecranon
  4. MRI Elbow
    1. High sensitivity and specificity Triceps Tendon Rupture

VIII. Management

  1. Initial Splinting (e.g. emergency department)
    1. Splint the elbow in 30 degrees flexion to maximally approximate the torn tendon edges
  2. Conservative management (partial tears <50%)
    1. Splint in 30 degrees flexion for 4 to 6 weeks
    2. May consider flexion Block Bracing after Splinting for another 2-3 weeks
    3. Physical therapy
    4. Gradual return to to sports after Splinting/bracing after 5-6 weeks
    5. Typical return to full activity after 3 months
  3. Surgery
    1. Indications
      1. Complete Triceps Tendon Rupture
      2. Partial Triceps Tendon Tear >50%
    2. Post-surgical management
      1. Splint in 30 degrees flexion for 2 to 3 weeks
      2. Flexion block bracing after Splinting for another 3 weeks
      3. Gradual return to activity after Splinting/bracing
      4. Unrestricted activity at 6 months
      5. Expected normal elbow extension for at least 4 years after repair

IX. References

  1. Guignard (2024) Crit Dec Emerg Med 38(11): 20-1
  2. Gaviria (2020) JBJS Rev 8(4):e0172 +PMID: 32539261 [PubMed]
  3. Tom (2014) Clin J Sport Med 24(3):197-204 +PMID: 24157465 [PubMed]

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