I receive a large number of questions, and I’ve written several times about distal biceps tendon ruptures of the elbow. In this Ask Dr. Geier column, I write about a less common, but equally challenging, elbow tendon injury – a triceps tendon rupture.
Meg Manente in Newburgh, Indiana writes:
Dear Dr. Geier:
Four days ago, I face planted while I was pumping gas (attempted to quickly step over pump hose that was hooked up to my car and my high heel caught it). I went down twisting my ankle, shoe flew off and landed on my right forearm tucked under my body. Initially, I was concerned for my ankle (had an OATS graft on it five years ago) but my tricep right above my elbow is swollen, no bruising and my entire tricep is incredibly tender and sore. I cannot fully extend it and a full bend in is quite uncomfortable. It feels heavy/weak and I have some numbness through my forearm and ring/pinky ringers. I went to the doctor who took an X-ray and didn’t find avulsions. I am a healthy, in-shape 32 yr old female so this doctor said it is extremely rare for someone my age to tear or rupture their tricep. My question is, would an X-ray definitely show if I tore it? At what point, do you have a patient get an MRI? I appreciate any help as it difficult to do my hair, pull up pants, etc. This doctor only prescribed steroids and did not offer any suggestions such as if/how long to rest, ice or heat it, exercise or when I should expect it to feel back-to-normal.
Mechanism of injury
The triceps muscles are the muscles in the back of the arm that extend (or straighten) the elbow. They are attached by a tendon to the olecranon, or the bony process at the tip of the elbow. These injuries occasionally occur in football, but it can potentially affect anyone. Usually a person is pushing away from the body when a traumatic force suddenly bends the elbow.
Tests for a triceps tendon rupture
Frequently the tendon pulls off the bone, so x-rays might appear normal. If the tendon pulls off part of the bone with it, that bony fragment can appear out of place on x-rays. If an orthopedic surgeon suspects a triceps tendon rupture based on pain, swelling and bruising on the back of the arm just above the elbow and the patient has difficulty extending the elbow, he or she might order an MRI. The MRI will reveal the tendon injury.
Surgery for a triceps tendon rupture
Treatment usually involves surgery. A partial tendon rupture might heal without surgery, but a complete rupture usually does require an operation. The surgeon makes an incision on the back of the elbow and reattaches the tendon to bone with stitches through drill holes or with suture anchors. Generally we perform the surgeries within weeks of the injury before the tendon retracts away from the bone, scars down or the muscles atrophy.
While the surgery is usually an outpatient procedure, it can take many months to return to sports or exercise. Usually the surgeon protects the elbow in a splint or brace early after surgery and slowly increases elbow motion. Physical therapy can improve range of motion and strength, and the patient slowly works back into daily activities, exercise and sports.
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