Bilateral triceps tendon tear. Radiol Case Rep. 2011;6:581. [PMID: 27307943 PMCID: PMC4900026 DOI: 10.2484/rcr.v6i4.581]

Surgical Management of Bilateral Triceps Muscle Rupture: A Case Report and Literature Review

Introduction

Triceps tendon avulsion is a rare tendinous injury that can be easily overlooked. If left untreated, such injuries can lead to a weakening of a patient's elbow extension and thereby cause significant disability; therefore, early identification and appropriate surgical intervention are important.

Case Report

We report bilateral triceps tendon avulsion injuries in a 49-year-old, right-hand dominant airline pilot. The patient fell while running and injured both his elbows. X-rays of both elbows showed displaced olecranon avulsion fractures, confirming triceps tendon injuries. Bone tendons were repaired with the suture anchor technique, and a solid repair was achieved. 3 months post-surgery, the post-operative progress of the patient was satisfied with full function, a range of motion of 5-150° on the left arm, and 0-150° on the right arm and ability to return to work with no restrictions.

Conclusion

Triceps tendon avulsion is a rare injury with few reported cases. Literature suggests that the successful outcome of the patient depends on early identification and timely intervention, such as surgical repair through a trans-osseous suture technique. Our report adds to the knowledge base available in the existing medical literature for future reference by healthcare professionals.

Distal triceps injuries (including snapping triceps): A systematic review of the literature

AIM

To review current literature on types of distal triceps injury and determine diagnosis and appropriate management.

METHODS

We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10^th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format.

RESULTS

Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4^th-5^th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical management includes resection of triceps edge or transposition of the tendon plus or minus ulna nerve transposition.

CONCLUSION

Distal triceps injuries are uncommon. This systematic review examines the evidence base behind diagnosis, imaging and treatment options of distal triceps injuries including tears and snapping triceps.