Elbow: Rupture of triceps tendon

Tendon ruptures around the elbow are common enough, but usually the biceps tendon is involved.

The triceps tendon ruptures are much less common, downright rare injuries. Below I describe one such injury.

This is a case of an adult male who ruptured the triceps while working out. He felt a large pop, and had pain in the back of the elbow immediately. He noticed weakness and pain with active elbow extension, and he sought surgical care immediately.

The diagnosis was suggested by history and physical examination. Xrays showed no bony injury. Ulstrasound, which I have in my office, confirmed the diagnosis of triceps rupture.

For complete triceps ruptures, surgical treatment is the correct treatment virtually everytime. The triceps muscle is a lone extensor of the elbow. Without a working triceps, the only other force that will help extend the elbow is the force of gravity.

What are the risks of this surgery?

  1. Death, as with any other surgery
  2. Infection, as with any other surgery
  3. Neurovascular injury: the ulnar nerve is potentially vulnerable, but in reality is far enough from the triceps tendon and should be safe.

How is the repair done?

The pictures below show various stages of dissection, repair, and wound closure.

This is a left elbow, bent, pointing straight at the camera. Hand is down, the shoulder is in the background.

In the first picture, the skin and the fascia have been incised. The triceps tendon is the irregular white structure marked by the arrow.

In the picture below, the triceps has been secured with a clamp.

Next, fiberwire sutures are placed in the tendon, a total of 4 strands. 4 suture strands are seen, one for each corner of the triceps tendon footprint.

The 2 deeper sutures are placed in bony tunnels in the olecranon. The superficial ones are not. After tying, the tendon is securely attached to the olecranon.

Next, the fiberwires are trimmed.

Fascia is then closed with dissolvable suture.

The skin is then closed.

After surgery, physical therapy is started immediately. Physical therapy protocol for this is fairly simple. Patient is was instructed to do passive and gravity extension, active flexion, but no active elbow extension against resistance for the first 6 weeks. Strengthening was started at 6 weeks.

Full strength and a pain free elbow is the goal. This objective was achieved in this case at 7 months after surgery.