‘Tricep Trauma’

Triceps are one of the largest muscle groups in the upper body. Primarily, they help to extend the elbow. They are involved in a ton of different activities. All kinds of pushing and pressing require the involvement of these muscles. About 33% larger than the biceps and brachialis combined, these muscles make up the bulk of the muscle mass of the arms. These are pennate muscles with 3 heads: long, lateral, and medial. The triceps are also prone to injuries. Triceps tendon ruptures occur most commonly in the area of the insertion of the olecranon. Fractures of the radial head are reported as the most common concomitant injuries. In many cases, pre-existing degenerative damage predisposes for tendon injury. These include local steroid injections, anabolic steroid abuse, renal insufficiency requiring dialysis, hyperparathyroidism, lupus erythematosus and Marfan’s syndrome.

What causes the injury?

Triceps tendon injuries usually occur as the result of a forceful eccentric contraction. It includes weightlifting as well as the use of the arms by football lineman to push opponents. Direct blunt trauma to the posterior aspect of the arm is a less common mechanism. Rarely, a laceration to the posterior arm can cause a rupture of the tendon.The injury usually involves avulsion of the tendon from the bone but can occur at the muscle tendon junction.

CLINICAL EVALUATION

An accurate history is critical in diagnosing a triceps tendon rupture. The patient most commonly reports a discrete injury to the elbow, often with an associated sensation of tearing or a pop.They often complain of a loss of elbow extension strength.On physical examination, ecchymosis and swelling are often present over the posterior aspect of the arm. A palpable divot may be present adjacent to the olecranon in the case of a retracted tear.Range of motion is typically full, although potentially limited by pain. Strength testing typically yields some degree of weakness with resisted elbow extension.Modified Thompson test can help in evaluation.

Diagnosis

Beside clinical examination and sonography, magnetic resonance imaging is the diagnostic gold standard.

Management

 The treatment of triceps tendon injuries includes conservative as well as operative approaches, whereby the indications for surgical treatment must be generously considered depending on the patient’s age, functional demands of the patient, involvement of the dominant extremity as well as on the extent of the tendon rupture.

Nonsurgical

1. Routine brief managementperiod of splint immobilisation (3–4 weeks) at 30⁰ of flexion.
2. Then a period is followed by progressive elbow flexion mobilisation.
3. Progression of elbow motion is allowed as tolerated after 4 weeks.

Post Operative Care

0 to 2 week – immobilisation of the elbow in 30⁰to 45⁰ of flexion

2to 6  week – Active range of motion of elbow initiated

6to 8 week  -Full range of motion of elbow

8 to 3 month – Light strengthening begins

4 to 6 month – Heavy lifting and weight training

Tricep Rehabilitation Exercise