Triceps tendon rupture
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- updated 10 May 2022:
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A triceps tendon rupture represents the extreme end of the spectrum of triceps tendon tears where there is complete detachment of the triceps tendon. It most often occurs at the distal end.
Pathology
If can either occur in an acute setting with trauma (e.g. as a result of a sudden forceful elbow contraction in weightlifters) or on a background of chronic triceps tendinopathic changes (older individuals with underlying systemic illnesses).
A rupture most commonly occurs at the osseous insertion of the medial or lateral head as a detachment of tendon from the bone.
Musculotendinous junction or intramuscular ruptures are considered very rare 4.
Risk factors
Chronic conditions which include
- chronic renal insufficiency requiring dialysis
- rheumatoid arthritis
- systemic lupus erythematosus (SLE)
- diabetes
- Marfan syndrome
- osteogenesis imperfecta
- metabolic bone diseases leading to hyperparathyroidism
- chronic olecranon bursitis: can increases the risk of rupture due to chronic inflammation around the tendon.
- underlying elbow arthroplasty
Radiographic features
Plain film
Non specific but may show an appearance of a flake"flake sign" or "fleck sign" on a lateral radiograph.
Ultrasound
May show a gap in tendon with lack of movement on dynamic interrogation +/- fusiform swelling and retraction of tendon / muscle portions.
MRI
MRI may overestimate tears 1 but may show a deficit - gap in the tendon +/- surrounding soft tissue inflammatory changes.
-<p>A <strong>triceps tendon rupture</strong> represents the extreme end of the spectrum of <a title="triceps tendon tears" href="/articles/triceps-tendon-tears">triceps tendon tears</a> where there is complete detachment of the triceps tendon. It most often occurs at the distal end.</p><h4>Pathology</h4><p>If can either occur in an acute setting with trauma (e.g. as a result of a sudden forceful elbow contraction in weightlifters) or on a background of chronic <a title="triceps tendinopathic changes" href="/articles/triceps-tendinopathic-changes">triceps tendinopathic changes</a> (older individuals with underlying systemic illnesses).</p><p>A rupture most commonly occurs at the osseous insertion of the medial or lateral head as a detachment of tendon from the bone.</p><p>Musculotendinous junction or intramuscular ruptures are considered very rare<sup> 4</sup>. </p><h5>Risk factors</h5><p>Chronic conditions which include</p><ul>- +<p>A <strong>triceps tendon rupture</strong> represents the extreme end of the spectrum of <a href="/articles/triceps-tendon-tears">triceps tendon tears</a> where there is complete detachment of the triceps tendon. It most often occurs at the distal end.</p><h4>Pathology</h4><p>If can either occur in an acute setting with trauma (e.g. as a result of a sudden forceful elbow contraction in weightlifters) or on a background of chronic <a href="/articles/triceps-tendinopathic-changes">triceps tendinopathic changes</a> (older individuals with underlying systemic illnesses).</p><p>A rupture most commonly occurs at the osseous insertion of the medial or lateral head as a detachment of tendon from the bone.</p><p>Musculotendinous junction or intramuscular ruptures are considered very rare<sup> 4</sup>. </p><h5>Risk factors</h5><p>Chronic conditions which include</p><ul>
-<a title="chronic renal insufficiency" href="/articles/chronic-renal-insufficiency">chronic renal insufficiency</a> requiring dialysis</li>-<li><a title="Rheumatoid arthritis" href="/articles/rheumatoid-arthritis">rheumatoid arthritis</a></li>- +<a href="/articles/chronic-renal-insufficiency">chronic renal insufficiency</a> requiring dialysis</li>
- +<li><a href="/articles/rheumatoid-arthritis">rheumatoid arthritis</a></li>
-<a title="Systemic lupus erythematosus" href="/articles/systemic-lupus-erythematosus">systemic lupus erythematosus</a> (SLE)</li>-<li><a title="diabetes" href="/articles/diabetes">diabetes</a></li>-<li><a title="Marfan syndrome" href="/articles/marfan-syndrome">Marfan syndrome</a></li>-<li><a title="Osteogenesis imperfecta" href="/articles/osteogenesis-imperfecta-1">osteogenesis imperfecta</a></li>- +<a href="/articles/systemic-lupus-erythematosus">systemic lupus erythematosus</a> (SLE)</li>
- +<li><a href="/articles/diabetes">diabetes</a></li>
- +<li><a href="/articles/marfan-syndrome">Marfan syndrome</a></li>
- +<li><a href="/articles/osteogenesis-imperfecta-1">osteogenesis imperfecta</a></li>
-<li>chronic <a title="olecranon bursitis" href="/articles/olecranon-bursitis">olecranon bursitis</a>: can increases the risk of rupture due to chronic inflammation around the tendon. </li>- +<li>chronic <a href="/articles/olecranon-bursitis">olecranon bursitis</a>: can increases the risk of rupture due to chronic inflammation around the tendon. </li>
-</ul><h4>Radiographic features</h4><h5>Plain film</h5><p>Non specific but may show an appearance of a flake sign on a lateral radiograph.</p><h5>Ultrasound</h5><p>May show a gap in tendon with lack of movement on dynamic interrogation +/- fusiform swelling and retraction of tendon / muscle portions.</p><h5>MRI</h5><p>MRI may overestimate tears <sup>1</sup> but may show a deficit - gap in the tendon +/- surrounding soft tissue inflammatory changes.</p><p> </p>- +</ul><h4>Radiographic features</h4><h5>Plain film</h5><p>Non specific but may show an appearance of a "flake sign" or "fleck sign" on a lateral radiograph.</p><h5>Ultrasound</h5><p>May show a gap in tendon with lack of movement on dynamic interrogation +/- fusiform swelling and retraction of tendon / muscle portions.</p><h5>MRI</h5><p>MRI may overestimate tears <sup>1</sup> but may show a deficit - gap in the tendon +/- surrounding soft tissue inflammatory changes.</p><p> </p>
References changed:
- 1. Kholinne E, Al-Ramadhan H, Bahkley A, Alalwan M, Jeon I. MRI Overestimates the Full-Thickness Tear of Distal Triceps Tendon Rupture. J Orthop Surg (Hong Kong). 2018;26(2):230949901877836. <a href="https://doi.org/10.1177/2309499018778364">doi:10.1177/2309499018778364</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/29871547">Pubmed</a>
- 2. Lee J, Ahn K, Kwon K, Kim K, Rhyou I. Differences in Rupture Patterns and Associated Lesions Related to Traumatic Distal Triceps Tendon Rupture Between Outstretched Hand and Direct Injuries. Clin Orthop Relat Res. 2021;479(4):781-9. <a href="https://doi.org/10.1097/CORR.0000000000001550">doi:10.1097/CORR.0000000000001550</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/33181575">Pubmed</a>
- 3. Tagliafico A, Gandolfo N, Michaud J, Perez M, Palmieri F, Martinoli C. Ultrasound Demonstration of Distal Triceps Tendon Tears. Eur J Radiol. 2012;81(6):1207-10. <a href="https://doi.org/10.1016/j.ejrad.2011.03.012">doi:10.1016/j.ejrad.2011.03.012</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/21420815">Pubmed</a>
- 4. Demirhan M & Ersen A. Distal Triceps Ruptures. EFORT Open Rev. 2016;1(6):255-9. <a href="https://doi.org/10.1302/2058-5241.1.000038">doi:10.1302/2058-5241.1.000038</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/28461956">Pubmed</a>
- 5. R K Singh & J Pooley. Complete Rupture of the Triceps Brachii Muscle. Br J Sports Med. 2002;36(6):467-9. <a href="https://doi.org/10.1136/bjsm.36.6.467">doi:10.1136/bjsm.36.6.467</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/12453845">Pubmed</a>
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