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Case of the Month - January 2020

Distal Triceps Tendon Rupture

Rupture of the distal triceps tendon at its attachment to the elbow is rare and among the least common tendon injuries. These injuries are two times more common in males than females. Most reports have associated triceps tendon rupture with anabolic steroid use and weight lifting, but distal triceps ruptures can also occur in athletes who do not use steroids including power lifters and football players.

The triceps brachii is a pennate muscle with three heads: lateral, long, and medial. The triceps extends the entire length of the posterior arm and is the only muscle located in the posterior compartment of the arm. The distal triceps tendon is a confluence of the three heads, as well as the lateral triceps expansion, and inserts over a wide area or footprint on the olecranon (posterior elbow). The main function of the triceps is to extend the forearm at the ulnohumeral (elbow) joint.

The most common mechanism of injury is a sudden eccentric load applied to a contracting triceps muscle, such as during weight lifting (i.e. bench pressing) or from a fall onto an outstretched hand. Lacerations or a direct blow trauma can also cause a rupture. Diagnosis is based on history, examination and imaging. Treatment decisions are individualized based on the patient’s medical and functional status. For example, a partial tear may be managed nonoperatively in a debilitated, elderly patient, while the same tear may be managed surgically in a highly functioning athlete.

In those patients indicated for surgery, repair should be performed within 2 weeks of injury when possible to limit tendon retraction. Surgical repair involves identification of the level of tendinous rupture with primary reattachment of the avulsed triceps tendon to the olecranon. This can be performed using high strength suture tied into the tendon and routed through tunnels in the bone or with suture anchors. Dr. Ziegler performs these repairs using both techniques.

Case: 44 year-old male powerlifter with Right distal triceps rupture sustained while benching 515 pounds! Click to play video!

Open distal triceps repair with suture anchors using a double row technique.

Three months after surgery, back to bench pressing! Click to play video!

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