Tricep Tendon Rupture
The triceps is a muscle located at the back of your upper arm, spanning from the top of the arm to the elbow. It plays an important role in extending (straightening) your elbow and stabilizing the elbow joint. At each end of the muscle there are strong bands of tissue that attach the muscle to bone known as a tendon. Triceps tendon rupture rarely occurs but if it does, it occurs usually at the part of the tendon that attaches to the elbow bone (Olecranon). It is also possible to have a tear in the muscle.
A triceps tendon tear most often results from severe trauma or significant force that causes the elbow to flex despite trying to extend the elbow, such as in a fall or trying to save yourself from a fall. It can also occur in competitive weightlifting and bodybuilding.
Several risk factors can increase the incidence of Triceps tears: oral steroid use, local corticosteroid injections to the tendon area, Fluoroquinolone antibiotics (Levaquin, Cipro), and systemic inflammatory conditions such as Rheumatoid Arthritis.
Patients usually experience sudden, severe pain in the arm or back of the elbow after the traumatic injury. There is sometimes a “pop” or “snap” that can be heard or felt when the tendon ruptures. It can lead to swelling and bruising in the elbow and forearm. There may be a bulge in the upper arm from where the muscle tendon retracted but it may not always be present. The pain and swelling can result in limited mobility of the elbow. Patients may feel weak when trying to straighten their elbow. After the initial tear however, the patient can sometimes feel relatively little pain or disability especially if they do not try to move it.
This condition is usually diagnosed starting with clinical information gathered from history and physical examination. Your physical examination will include inspection of the injured arm for any bruising, swelling, and visible or palpable defects. If possible, range of motion and strength will be evaluated.
Dr. Steven Lee will often order an X-ray in addition to rule out possible fractures or other diagnoses. Occasionally, there may be a piece of bone pulled off from where the tendon was attached. Other diagnostic studies such as MRI may be ordered to help confirm the diagnosis and guide further treatment.
Determination of management for triceps ruptures depends on the extent of the tear, location of the tear and the patient’s individual circumstances. Non-surgical treatment may be suitable if there is minimal or partial tearing of the tendon, especially if the tear is in the muscle area as opposed to the tendon, and in patients who have medical conditions or complications that may put them at high risk for surgery. Patients do have to keep in mind that they will not regain full strength and function if a complete tear is not repaired. There is always a chance that a partial tear may progress to a complete tear as well.
If recommended nonsurgical course of treatment, patients will usually begin with immobilization of the elbow initially to allow the injury to heal. Physical therapy is then started to reduce pain and swelling from the trauma as well as to regain mobility and strength. Stretches and exercises may be involved in order to strengthen other muscles in the arm.
Surgery is usually recommended for complete Triceps tendon tears in order to reattach the tendon to regain arm strength, mobility and function. The procedure should be performed as soon as possible because the tendon will start to scar over, shorten, and weaken over time frame, causing a suboptimal result.
Repair of the triceps tendon involves making an incision over the back of the elbow, retrieving the torn tendon, placing strong sutures in the tendon and re-attaching the tendon to back of the elbow with anchors or tunnels drilled into bone. Occasionally, the surgery may require reconstruction of the tendon if the tendon may be far too damaged to repair or the tendon rupture was untreated for a long period of time. Reconstruction will involve using transplanted or tendon graft tissue to recreate the tendon.
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After surgery, patient will be placed into a splint, spanning from their upper arm down the the hand, to protect the surgical repair. Patients usually follow up in office to evaluate the surgical site within 7-10 days after the surgery. At this time, the surgical incision site will be checked and if ready, sutures will be removed.
During the recovery period, patients are advised to avoid activities such as pushing, pulling, carrying or excessive overhead motions with the affected arm. You should be able to use your fingers for light activities such as using a phone or computer.
At the first postoperative visit, patients may be transitioned to a hard cast or a brace strapped from the upper arm down to the wrist. This casting/brace period can last from 4-6 weeks. The elbow will initially be immobilized and unable to move. Gradually, motion is started slowly and progressively increased over time with physical therapy.
Physical therapy will be initiated gradually during the rehabilitation period, starting with gentle range of motion exercises to regain mobility and modalities to decrease pain and swelling. Strengthening exercises are then gradually added to the therapy protocol.
It is important to note that Triceps tendon tears often take an exceedingly long time to recover, sometimes up to a year or longer. It is also possible that even with surgical treatment, residual weakness and even pain is possible due to the nature of this problem.
Immediate Post-Operative Instructions
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*It is important to note that all of the information above is not specific to anyone and is subject to change based on many different factors including but not limited to individual patient, diagnosis, and treatment specific variables. It is provided as an educational service and is not intended to serve as medical advice. Anyone seeking specific orthopedic advice or assistance should consult Dr. Steven Lee or an orthopedic specialist of your choice.
*Dr. Steven Lee is a board certified orthopedic surgeon and is double fellowship trained in the areas of Hand and Upper Extremity Surgery, and Sports Medicine. He has offices in New York City, Scarsdale, and Westbury Long Island.