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 called the tendon. Triceps tendonitis is an inflammation of the tendon that attaches the muscle to the olecranon (the area of the forearm bone at the back of your elbow). Although an acute trauma can also cause it, tendonitis usually starts out slowly and becomes more bothersome as the arm is used over time. Repeated use, strain, or irritation can cause inflammation of the tendon and if allowed to continue, may progress to cause tears in the tendon.
Triceps tendonitis can occur in manual laborers, weekend warriors, and athletes. Often, it results from overuse and overactivity such as pushing objects, hammering, throwing pitches in baseball, lifting weights, punches in boxing, gymnastics, or doing push ups, bench presses, or triceps dips in the gym.
Sometimes, in patients who have this condition chronically, bone spurs at the back of the elbow can grow from irritation and inflammation over time or from osteoarthritis.
Patients often complain of pain at the back of the elbow or upper arm. The pain is usually exacerbated by motions that involve extending (straightening) the elbow. Tenderness to touch at the Triceps insertion on the elbow is usually present. Occasionally, the inflammation can cause swelling in the area at the back of the elbow. In some cases, pain from the condition may limit range of motion of the elbow.
This condition is usually diagnosed starting with clinical information gathered from history and physical examination. Your physical examination will include evaluation of the affected extremity including assessing points of muscle and tendon tenderness, range of motion and strength.
Dr. Steven Lee will often order an X-ray in addition to evaluate the bony anatomy, assess for any bone spurs, and rule out other possible diagnoses. Occasionally, other diagnostic studies such as MRI might be ordered to rule out tears in the tendon or other possible causes for chronic pain despite treatment.
Most patients will improve with a combination of good rest, activity modification, and physical therapy. Patients are advised to avoid activities that may cause pain or exacerbate the problem such as throwing, weight lifting, or doing triceps related exercises in the gym. Home remedies such as using heat over the muscle area prior to activities, and applying ice over the back of the elbow after activities can be helpful. Some patients also find some relief with use of pain medications such as Tylenol or NSAIDs (e.g. Advil, Ibuprofen, Motrin) if they are able to tolerate the medication and not contraindicated. Physical therapy is usually recommended and can involve going through specific stretches, therapeutic modalities such as massage or stimulation, and exercises to gently and progressively strengthen the triceps muscle and surrounding muscles to reduce strain on the tendon. As symptoms improve, patients may gradually return to sport or activity as tolerated.
If patients still experience chronic pain despite initial management, other treatments can be consider. Steroid injections into the tendon are usually avoided. Studies have shown that cortisone injections may lead to weakening of an injured tendon, worsening tears or even rupture of tendons. If there is damage to the tendon seen on MRI testing, Platelet Rich Plasma injections may be considered to kickstart a healing response at the tendon. PRP (Platelet Rich Plasma) injections and other stem cell treatments have shown promise in certain patients and can be discussed with Dr. Steven Lee.
Surgical intervention may be helpful for patients who have chronic pain despite exhausting all non-surgical treatment options. Surgery involves debriding or removing the chronically inflamed or degenerated tendon, and repairing with sutures any portion of the tendon that might be torn. If there is a bone spur present, the piece of bone may be removed during the surgery as well.
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. Patients should be able to use your fingers for light activities such as using a phone or computer.
At the first postoperative visit, depending on the severity of the surgery and patient preference, patients may be transitioned to a hard cast or a removable brace. This casting/brace period can last from 4-6 weeks, again depending on the severity and type of surgery performed. Physical therapy will then 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. Often full recovery for this can take anywhere between 2-3 months, and in severe cases, even longer.
Immediate Post-Operative Instructions
Please refer to the following pages for more information:
*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.