Triceps Tendon Rupture
Other popular names
Who does it affect?
This is a very rare condition. It occurs most commonly after total elbow arthroplasty and in this situation may go unrecognised as gravity will do much of the work of elbow extension. Traumatic distal triceps avulsion occurs most commonly in contact sports.
Why does it happen?
It happens usually as the tendon is degenerating and a sudden load is experienced.
A history of pain, swelling and bruising at the back of the elbow after a forced flexion in an extended elbow would raise the possibility of triceps avulsion.
Therefore, early surgical repair is required to restore full strength and correct the deformity. Repair should be undertaken within 3 weeks of the injury, or as early as possible.
The elbow will be examined with you lying supine with your shoulder flexed to 90 degrees. The strength of elbow extension can then be assessed while I examine the tendon for a defect.
Investigations are normally not necessary as the condition is well known and easy to identify. Ultrasound or MRI scans may be used to examine tissue damage.
There are no non-surgical treatments available. Ice should be used to reduce swelling and a strapping may be used to minimise pain until surgery can be undertaken.
Surgery is carried out as a day case procedure usually under general anaesthetic and takes about 30-45 minutes
Various techniques are described for repair of the distal triceps. Anatomical footprint repair my most favoured technique for acute ruptures (within three weeks of injury) with transosseous sutures or suture anchors. For delayed ruptures, I may need to consider hamstring grafts taken from your thigh.
You can go home soon after the operation. The anaesthetic will wear off after approximately 6 hours. Simple analgesia (pain killers) usually controls the pain and should be started before the anaesthetic has worn off. The dressing will be removed soon after your operation. The wound is cleaned and redressed with a simple dressing. Avoid forced gripping or lifting heavy objects for 2-3 weeks. The sutures are removed at about 10 days.
It can take up to 6-12 months to regain the full strength of your triceps.
Return to normal routine
Keep the wound dry until the stitches are out at 10 days.
Return to driving:
The hand needs to have full control of the steering wheel and left hand the gear stick. You are advised to avoid driving for at least 7 days or until the sutures (stitches) and any bracing is removed.
Return to work:
Everyone has different work environments. Returning to heavy manual labour should be prevented for approximately 12 - 16 weeks. Early return to heavy work may cause the tendons and nerve to scar into the released ligament. You will be given advice on your own particular situation.
Overall over 95% are happy with the result. However complications can occur.
General risks (less than 1% each):
- Neuroma (nerve pain)
Reflex Sympathetic Dystrophy - RSD (<1% people suffer a reaction to surgery with painful stiff hands, which can occur with any elbow surgery from a minor procedure to a complex reconstruction).
- Tendon re-rupture