Abstract
Triceps tendon tear is a relatively rare injury. Rupture is often associated with pre-existing systemic conditions or drug treatments, including the local or systemic of steroids. Patients tend to be men who practice sports and are from 30 to 50 years of age. Injury is commonly caused by falls on an outstretched hand, direct trauma on the elbow, or lifting against resistance. The clinical examination may detect pain, a palpable tendon gap, and extension weakness, while a pathognomonic flake sign may be seen on radiographs. Magnetic resonance imaging is widely accepted as the gold standard to evaluate the size and extension of the tear: triceps lesions often occur at the tendon insertion and result in either partial or total tears.
Conservative treatment may be adopted for partial tears, with patients normally being able to return to sports or heavy activities after 4–6 months, when symptoms have resolved and strength has almost returned to normal. Nevertheless, patients need to be followed closely throughout this period to ensure that the lesion does not worsen.
Primary repair of complete triceps injury should be performed as soon as possible to guarantee the recovery of daily functions and sports activity 3 and 5 months postoperatively, respectively, minimizing the risk of re-rupture at the same time. Postoperative care is based on elbow immobilization for 3–4 weeks and flexion block bracing for a further 2–3 weeks. Full flexion and active extension are normally initiated 6–8 weeks postoperatively. The recovery of extension strength against resistance starts after 12 weeks, whereas unrestricted activity is allowed after 5–6 months.
Delayed diagnosis and treatment may complicate primary repair and lead to the need for reconstructive procedures. Small defect reconstruction by means of the anconeus rotation procedure ensures full ROM and strength in the long term. By contrast, an allograft using an Achilles tendon or hamstring autograft is required in chronic cases associated with large tendon gaps. A long rehabilitation period is to be expected in such cases, and muscle strength may only partially be regained. The postoperative protocol adopted in augmentation procedures is the same as that adopted for primary repair, though each step needs to be delayed by 2–3 weeks.
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References
Anzel SH, Covey KW, Weiner AD et al (1959) Disruption of muscles and tendons: an analysis of 1,014 cases. Surgery 45:406–414
Aso K, Torisu T (1984) Muscle belly tear of the triceps. Am J Sports Med 12:485–487
Athwal GS, McGill RJ, Rispoli DM (2009) Isolated avulsion of the medial head of the triceps tendon: an anatomic study and arthroscopic repair in 2 cases. Arthroscopy 25:983–988
Bava ED, Barber FA, Lund ER (2012) Clinical outcome after suture anchor repair for complete traumatic rupture of distal triceps tendon. Arthroscopy, 28(8):1058–1063
Blackmore SM, Jander RM, Culp RW (2006) Management of distal biceps and triceps ruptures. J Hand Ther 19:154–168
Brumback RJ (1987) Compartment syndrome complicating avulsion of the origin of the triceps muscle: a case report. J Bone Joint Surg Am 69:1445–1447
Chan AP, Lo CK, Lam HY et al (2009) Unusual traumatic triceps tendon avulsion rupture: a word of caution. Hong Kong Med J,15(4):294–296
Clayton ML, Thirupathi RG (1984) Rupture of the triceps tendon with olecranon bursitis: a case report with a new method of repair. Clin Orthop Relat Res 184:183–185
Daglar B, Delialioglu OM, Ceyhan E et al (2009) Combined surgical treatment for missed rupture of triceps tendon associated with avulsion of the ulnar collateral ligament and flexor-pronator muscle mass. Strategies Trauma Limb Reconstr 4:35–39
Dos Remedios C, Brosset T, Chantelot C et al (2007) Repair of a triceps tendon rupture using autogenous semi-tendinous and gracilis tendons: a case report and retrospective chart review [French]. Chir Main 26:154–158
Duchow J, Kelm J, Kohn D (2000) Acute ulnar nerve compression syndrome in a powerlifter with triceps tendon rupture: a case report. Int J Sports Med 21:308–310
Farrar EL III, Lippert FG III (1981) Avulsion of the triceps tendon. Clin Orthop Relat Res 161:242–246
Gerbeaux M, Turpin E, Lensel-Corbeil G (1996) Musculo-articular modelling of the triceps brachii. J Biomech 29:171–180
Giannicola G, Sacchetti FM, Bullitta G et al (2012) Distal triceps tendon ruptures. Poster. In: 24th Congress of the European Society for surgery of the shoulder and the elbow, Dubrovnik, Croatia, 19–22 September 2012
Gilcreest EL (1925) Rupture of muscles and tendons. JAMA 84:1819–1822
Gray H (1959) Anatomy of the human body. In: Gross C (ed) Anatomy of the human body. Lea & Febiger, Philadelphia, PA, pp 460–461
Gupta RR, Murthi AM (2010) Distal humeral fracture with associated triceps tendon avulsion in a renal transplant recipient. Orthopedics 10:204–207
Haldeman KO, Soto-Hall R (1935) Injuries to muscles and tendons. JAMA 104:2319–2324
Harris PC, Atkinson D, Moorehead JD (2004) Bilateral partial rupture of triceps tendon: case report and quantitative assessment of recovery. Am J Sports Med 32:787–792
Hughes RE, Schneeberger AG, An KN et al (1997) Reduction of triceps muscle force after shortening of the distal humerus: a computational model. J Shoulder Elb Surg 6:444–448
Inhofe PD, Moneim MS (1996) Late presentation of triceps rupture: a case report and review of the literature. Am J Orthop (Belle Mead NJ) 25:790–792
Kaempffe FA, Lerner RM (1996) Ultrasound diagnosis of triceps tendon rupture: a report of 2 cases. Clin Orthop Relat Res 332:138–142
Kandemir U, Fu FH, McMahon PJ (2002) Elbow injuries. Curr Opin Rheumatol 14:160–167
Keener JD, Chafik D, Kim HM et al (2010) Insertional anatomy of the triceps brachii tendon. J Shoulder Elb Surg 19:399–405
Kibuule LK, Fehringer EV (2007) Distal triceps tendon rupture and repair in an otherwise healthy pediatric patient: a case report and review of the literature. J Shoulder Elb Surg 16:e1–e3
Kijowski R, Tuite M, Sanford M (2005) Magnetic resonance imaging of them elbow: part II. Abnormalities of the ligaments, tendons, and nerves. Skelet Radiol 34:1–18
Kokkalis ZT, Mavrogenis AF, Spyridonos S et al (2013) Triceps brachii distal tendon reattachment with a doublerow tecnique. Orthopedics, 36(2):110–116
Koplas MC, Schneider E, Sundaram M (2011) Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation. Skelet Radiol 40(5):587–594
Kose O, Kilicaslan OF, Guler F et al (2015) Functional outcomes and complications after surgical repair of triceps tendon rupture. European Journal of Orthopaedic Surgery and Traumatology 25 (7):1131–1139
Lambert MI, St Clair Gibson A, Noakes TD (1995) Rupture of the triceps tendon associated with steroid injections. Am J Sports Med 23:778
Lempainen L, Sarimo J, Rawlins M et al (2011) Triceps tears in athletes: different injury patterns and surgical treatment. Arch Orthop Trauma Surg 131(10):1413–1417
Levy M, Fishel RE, Stern GM (1978) Triceps tendon avulsion with or without fracture of the radial head–a rare injury? J Trauma 18(9):677–679
Levy M, Goldberg I, Meir I (1982) Fracture of the head of the radius with a tear or avulsion of the triceps tendon. J Bone Joint Surg (Br) 64:70–72
Madsen M, Marx RG, Millett PJ et al (2006) Surgical anatomy of the triceps brachii tendon: anatomical study and clinical correlation. Am J Sports Med 34:1839–1843
Mair SD, Isbell WM, Gill TJ et al (2004) Triceps tendon ruptures in professional football players. Am J Sports Med 32:431–434
McCulloch PC, Spellman J, Bach BR Jr (2008) Familial triceps tendon ruptures. Orthopedics 31:600–602
Montgomery AH (1920) Two cases of muscle injury. Surg Clin Chic 4:871–877
Morrey BF (2009) Functional evaluation of the elbow. In: Morrey BF (ed) The elbow and its disorders, 4th edn. WB Saunders, Philadelphia, PA, pp 536–546
Neumann H, Schulz AP, Breer S et al (2015) Traumatic Rupture of the Distal Triceps Tendon (A Series of 7 Cases). The Open Orthopaedics Journal 9(1):536–541
Newmark H III, Olken SM, Halls J (1985) Ruptured triceps tendon diagnosed radiographically. Australas Radiol 29:60–63
O’Driscoll SW (1992) Intramuscular triceps rupture. Can J Surg 35:203–207
O'Driscoll SW, Goncalves LB, Dietz P (2007) The hook test for distal biceps tendon avulsion. Am J Sports Med 35(11):1865–1869
Penhallow DP (1910) Report of a case of ruptured triceps due to direct violence. NY Med J 91:76–77
Petre BM, Grutter PW, Rose DM et al (2011) Triceps tendons: a biomechanical comparison of intact and repaired strength. J Shoulder Elb Surg 20:213–218
Pina A, Garcia I, Sabater M (2002) Traumatic avulsion of the triceps brachii. J Orthop Trauma 16:273–276
Rettig AC (2002) Traumatic elbow injuries in the athlete. Orthop Clin North Am 33:509–522
Sai S, Fujii K, Chino H, Inoue J et al (2004) Old rupture of the triceps tendon with unique pathology: a case report. J Orthop Sci 9:654–656
Sanchez-Sotelo J, Morrey BF (2002) Surgical techniques for reconstruction of chronic insufficiency of the triceps: rotation flap using anconeus andendo achillis allograft. J Bone Joint Br 84:1116–1120
Searfoss R, Tripi J, Bowers W (1976) Triceps brachii rupture: case report. J Trauma 16:244–246
Sharma SC, Singh R, Goel T et al (2005) Missed diagnosis of triceps tendon rupture: a case report and review of literature. J Orthop Surg (Hong Kong) 13:307–309
Sheps D, Black B, Reed M et al (1997) Rupture of the long head of the triceps muscle in a child: case report and review of the literature. J Trauma 42:318–320
Sherman OH, Snyder SJ, Fox JM (1984) Triceps tendon avulsion in a professional body builder. A case report. Am J Sports Med 12:328–329
Sierra RJ, Weiss NG, Shrader Mw et al (2006) Acute triceps ruptures: Case Report and retrospective chart review. J Shoulder Elbow,15:130–134
Singh RK, Pooley J (2002) Complete rupture of the triceps brachii muscle. Br J Sports Med 36:467–469
Sollender JL, Rayan GM, Barden GA (1998) Triceps tendon rupture in weight lifters. J Shoulder Elb Surg 7:151–153
Strauch RJ (1999) Biceps and triceps injuries of the elbow. Orthop Clin North Am 30:95–107
Tarallo L, Zambianchi F, Mugnai R et al (2015) Distal triceps tendon repair using Krakow whipstitches, K wires, tension band and double drilling technique: a case report. J Med Case Rep 9(1):504
Tatebe M, Horii E, Nakamura R (2007) Chronically ruptured triceps tendon with avulsion of the medial collateral ligament: a report of 2 cases. J Shoulder Elb Surg 16:e5–e7
Thornton R, Riley GM, Steinbach LS (2003) Magnetic resonance imaging of sports injuries of the elbow. Top Magn Reson Imaging 14:69–86
Tsourvakas S, Gouvalas K, Gimtsas C et al (2004) Bilateral and simultaneous rupture of the triceps tendons in chronic renal failure and secondary hyperparathyroidism. Arch Orthop Trauma Surg 124:278–280
Van Riet RP, Morrey BF, Ho E et al (2003) Surgical treatment of distal triceps ruptures. J Bone Joint Surg Am 85:1961–1967
Vidal AF, Drakos MC, Allen AA (2004) Biceps tendon and triceps tendon injuries. Clin Sports Med 23:707–722
Viegas SF (1990) Avulsion of the triceps tendon. Orthop Rev 19:533–536
Wagner JR, Cooney WP (1997) Rupture of the triceps muscle at the musculotendinous junction: a case report. J Hand Surg [Am] 22(341–343):15
Weistroffer JK, Mills WJ, Shin AY (2003) Recurrent rupture of the triceps tendon repaired with hamstring tendon autograft augmentation: a case report and repair technique. J Shoulder Elb Surg 12:193–196
Weng PW, Wang SJ (2006) Wu SS (2006) misdiagnosed avulsion fracture of the triceps tendon from the olecranon insertion: case report. Clin J Sport Med 16:364–365
Windisch G, Tesch NP, Grechenig W et al (2006) The triceps brachii muscle and its insertion on the olecranon. Med Sci Monit 12:BR290–BR294
Wolf JM, McCarty EC, Ritchie PD (2008) Triceps reconstruction using hamstring graft for triceps insufficiency or recurrent rupture. Tech Hand Up Extrem Surg 12:174–179
Yeh PC, Stephens KT, Solovyova O et al (2010a) The distal triceps tendon footprint and a biomechanical analysis of 3 repair techniques. Am J Sports Med 38:1025–1033
Yeh PC, Dodds SD, Smart LR et al (2010b) Distal triceps rupture. J Am Acad Orthop Surg 18:31–40
Yoon MY, Koris MJ, Ortiz JA et al (2012) Triceps avulsion, radial head fracture, and medial collateral ligament rupture about the elbow: a report of 4 cases. J Shoulder Elb Surg 21(2):e12–e17
Zionts LE, Vachon LA (1997) Demonstration of avulsion of the triceps tendon in an adolescent by magnetic resonance imaging. Am J Orthop 26:489–490
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Giannicola, G., Bullitta, G., Sacchetti, F.M., Polimanti, D., Scacchi, M. (2018). Triceps Ruptures. In: Porcellini, G., Rotini, R., Stignani Kantar, S., Di Giacomo, S. (eds) The Elbow. Springer, Cham. https://doi.org/10.1007/978-3-319-27805-6_28
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