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. Ruptures are rare in the general population, as they only occur with substantial force.
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 upper arm
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 weight lifting and contact sports like football. An underlying medical condition (such as rheumatoid arthritis) or the use of anabolic steroids can also increase the risk of a partial or complete triceps tear. More rare causes include the use of fluoroquinolone antibiotics (such as ciprofloxacin or Cipro) and previous elbow surgeries. 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).
Triceps tears are diagnosed by a medical provider based on the person’s history of injury and through a physical examination, x-rays, and sometimes other imaging scans like MRIs.
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. Whether a triceps tear requires surgical repair depends on the characteristics of the tear in addition to the person’s level of activity and goals.
How surgery is performed
If surgery is recommended, it should ideally be done relatively soon (i.e., within two to three weeks of the injury). If the injury is not treated promptly, over time the tendon and muscle will scar and shorten, making it harder to repair.
Surgery involves making a cut on the back of the arm near the elbow and locating the broken 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 small 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. Anchors help lock the stitches in place on the bone.
After surgery, the arm is immobilized in a splint for approximately two weeks to protect it. Pain medication can be taken to alleviate discomfort, and people may require help to eat, bathe, and dress.
After splinting, a removable brace that allows the elbow to bend should be worn for up to eight weeks. Physical therapy is recommended during this time to regain elbow motion and strength. Athletes who have had a triceps tendon repair may generally begin weight lifting again after four to six months.
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.
During follow-up appointments, Dr. Romeo will perform a physical examination and evaluate x-rays to monitor healing. He will also advise when to resume work and other day-to-day activities. After surgery, it can take up to a year to recover full range of motion and strength.
Are there any risks associated with distal triceps tear repairs?
Complications are rare following a distal triceps tendon repair. The most common complication is flexion contractures of between 5° and 20°, as seen in 10% of cases. This means that there is a slight permanent bend in the elbow. In cases with difficult passive extension during the surgery, a night splint at full extension may be used after surgery. There is also potential for wound infections due to the thin tissues at the tendon insertion site, but this is rare.