Triceps Tendon Ruptures: Risk Factors, Treatment, and Rehabilitation

Reconstruction of the Proximal Portion of the Brachial Triceps Muscle with Homologous Graft: A Case Report

Introduction

Injuries to the brachial triceps (BT) tendon are rare, accounting for about 1% of all tendon injuries. The complexity of these injuries, especially in their proximal portion, and the scarcity of data in the literature make each case essential to expand knowledge. This report demonstrates an effective treatment method for extensive muscle loss around the shoulder using a homologous graft, offering new perspectives for similar cases.

Case Report

A 65-year-old female patient presented with a history of desmoid tumor treated surgically through an extensive surgical resection of the proximal portion of the BT muscle, followed by a third-degree burn in the left scapular region. The patient exhibited sequelae, manifesting complaints related to esthetics and reduced active extension of the elbow. Hypotrophy of the deltoid muscle was also observed, associated with paresthesia in the corresponding C5 dermatome. The patient underwent surgical treatment for reconstruction of the proximal portion of the BT muscle using a homologous graft from the tensor fascia lata muscle, which resulted in esthetic and functional improvements without additional neurological deficits.

Conclusion

The case report demonstrates that reconstruction of the proximal portion of the BT muscle with a homologous graft is a promising approach for treating this type of injury, bringing significant improvements in muscle function and esthetics. Furthermore, a multidisciplinary approach, postoperative surveillance, and the continuous pursuit of technical advancements are essential to optimize results and minimize complications, broadening therapeutic options in complex cases.

Rehabilitation following distal triceps repair: A scoping review

BACKGROUND

Distal triceps ruptures are relatively rare injuries where surgical repair is recommended for return to function and sport. There are various fixation techniques and different therapy protocols described in the literature.

PURPOSE

To scope and critically evaluate current knowledge of post-operative protocols and complications following repair and extrapolate tendon healing principles to clinical practice.

STUDY DESIGN

Scoping review.

METHODS

The Joanna Briggs Institute framework for Scoping Reviews was followed, and specific inclusion/exclusion criteria were applied to identify high-quality, relevant evidence. Studies were included if they met the following criteria: written in English, focused on adults over 17 years of age with complete distal triceps tendon ruptures, and published as peer-reviewed articles, conference abstracts, university dissertations, or theses. Additionally, the studies had to use at least one validated outcome measure. Electronic and manual searches were completed of published and gray literature. Quantitative sources were included for complete triceps ruptures that measured outcomes using at least one validated outcome measure. Qualitative sources that were published within 10 years from a reputable journal were included for qualitative synthesis.

RESULTS

Eighteen quantitative articles consisting of case series and systematic reviews, and 16 expert opinion and narrative reviews met the inclusion criteria. There was no standardized postoperative protocol with differences found in timing for ranging, strengthening, and return to function. The most reported complications were tendon rerupture, infection, pain, and ulnar nerve neuropathy.

CONCLUSIONS

What is known about triceps tendon repairs comes from low level evidence. Randomized controlled trials are required to evaluate the effect of surgical constructs and therapy on function. The protocols identified in this scoping review typically progressed through several stages, starting with complete immobilization and moving on to ranging, strengthening, and finally returning to sport and functional activities. Therapists can apply general tendon healing principles when rehabilitating these patients and should be aware of modifiers to healing timeframes when making decisions on strengthening and resuming activities that require high function.

Time-sensitive injuries for the sports medicine surgeon - "Sports Medicine Trauma", Part 1: Upper Extremity

Skeletal fractures are traumatic injuries that are widely accepted as requiring acute treatment to avoid long-term disability and dysfunction. There are a number of soft-tissue injuries or non-traditional fractures, frequently treated by sports medicine surgeons, which additionally require treatment in an expedited fashion in order to optimize healing and function. Sports medicine injuries of the lower extremity requiring acute treatment include, but are not limited to, irreducible shoulder dislocations, acute traumatic rotator cuff tears, posterior sternoclavicular joint dislocations, high grade acromioclavicular joint dislocations, pectoralis major tendon ruptures, distal biceps tendon ruptures, and triceps tendon ruptures. The purpose of this manuscript is to review the sports medicine injuries of the upper extremity which require acute/urgent management to facilitate optimal treatment.

Distal Triceps Tendon Repair in Strength Athletes Leads to Satisfactory Return to Sports: A Retrospective Analysis of 22 Cases

Background: Distal triceps brachii tendon rupture (DTTR) is a relatively rare injury that is common in bodybuilding and high-intensity contact sports and can lead to significant functional impairment of the elbow joint. This study was conducted to evaluate clinical outcomes and the rate of return to sports among competitive bodybuilders and high-demand strength athletes after surgical repair of DTTR. Methods: This retrospective case series was performed in an institutional setting in tertiary health care. Return to sports of 22 competing or high-demand strength athletes (meaning three or more exercises per week) were analyzed pre- and postoperatively after surgical repair of DTTR using a hybrid technique of transosseous sutures and anchor fixation. Descriptive statistics were used to analyze demographic variables, and independent and paired t-tests were used to assess clinical outcomes. Results: The follow-up showed that from pre- to postoperatively, there was no deterioration in the number of sports disciplines (2.4 and 2.5 sporting activities per person, respectively; p = 0.540) or in the frequency of weekly training (4.1 and 4.1 times per person, respectively; p = 0.329). The postoperative visual analog scale for pain (from 6.0 to 1.6, p < 0.001), level of fitness (from 5.1 to 2.6, p = 0.002), and ability to train (from 5.2 to 1.3, p < 0.001) improved significantly. The time of return to sports was 1.5-3 months and 4-6 months after the surgery for ten patients each. The overall rate of return to sports was 95%, whereas 86% returned to the preinjury level of sporting activity. Conclusions: Repair of DTTR leads to high rates of return to sports in competitive athletes.

Isolated traumatic triceps tendon rupture following a motorcycle accident: a case report

Triceps tendon ruptures are rare but significant injuries that impair upper extremity function. Despite their infrequency, recognizing this condition is crucial due to its severe impact on arm movement and strength. Patients typically present with posterior elbow pain, swelling, and bruising.This report details a complete triceps tendon rupture in a 34-year-old male following trauma. The patient exhibited classic symptoms: posterior elbow pain, significant swelling, and visible bruising, initially suggesting a severe soft tissue injury. Clinical examination and imaging confirmed a complete triceps tendon rupture. This case highlights the importance of considering triceps tendon rupture in patients with similar symptoms, particularly after trauma. Early recognition and accurate diagnosis are essential for timely surgical intervention, significantly improving functional recovery. Delayed diagnosis and treatment can lead to prolonged disability and poor outcomes, emphasizing the need for heightened awareness among healthcare providers regarding this rare but serious injury.

Partial ruptures of the distal triceps tendons show only slightly lower ultimate load to failure: a biomechanical study

OBJECTIVE

Partial ruptures of the distal triceps tendon are usually treated surgically from a size of > 50% tendon involvement. The aim of this study was to compare the ultimate load to failure of intact triceps tendons with partially ruptured tendons and describe the rupture mechanism.

METHODS

Eighteen human fresh-frozen cadaveric elbow specimens were randomly assigned to two groups with either an intact distal triceps tendon or with a simulated partial rupture of 50% of the tendon. A continuous traction on the distal triceps tendon was applied to provoke a complete tendon rupture. The maximum required ultimate load to failure of the tendon in N was measured. In addition, video recordings of the ruptures of the intact tendons were performed and analysed by two independent investigators.

RESULTS

A median ultimate load to failure of 1,390 N (range Q_0.25-Q_0.75, 954 - 2,360) was measured in intact distal triceps tendons. The median ultimate load to failure of the partially ruptured tendons was 1,330 N (range Q_0.25-Q_0.75, 1,130 - 1.470 N). The differences were not significant. All recorded ruptures began in the superficial tendon portion, and seven out of nine tendons in the lateral tendon portion.

DISCUSSION

Partial ruptures of the distal triceps tendon demonstrate a not statistically significant lower ultimate load to failure than intact tendons and typically occur in the superficial, lateral portion of the tendon. This finding can be helpful when deciding between surgical and conservative therapy for partial ruptures of the distal triceps tendon.

Functional Considerations in Bilateral, Simultaneous Tendon Injuries of the Upper Extremity: A Narrative Review of Current Literature

» Bilateral, simultaneous same-tendon injuries of the upper extremity are rarely encountered, yet their unique complexity poses a substantial challenge for treating orthopaedic surgeons.» In general, extremities with more tendon retraction should be repaired acutely while contralateral injuries can be treated in a staged or simultaneous manner depending on injury morphology, location, and anticipated functional impairment.» Combinations of accelerated and conventional rehabilitation protocols can be used for individual extremities to minimize the length of functional impairment.

[Lesions of the triceps tendon : Diagnostics, management, treatment]

The triceps brachii muscle is the main extender of the elbow joint. Triceps tendon rupture or tearing presents a rare injury pattern in general. Distal 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 injury. 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. However, the most frequent trauma mechanism is a direct fall onto the extended forearm or a blow to the elbow. Beside clinical examination and sonography, magnetic resonance imaging is the diagnostic gold standard. 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.