Avulsion of the triceps tendon

Case contributed by Imran Ahmad Khan


Right elbow pain following a slip and fall at home. Pain is of severe intensity associated with swelling and restriction of elbow movements. On inspection, swelling and tenderness over olecranon. Active extension not possible.

Patient Data

Age: 15 years
Gender: Male

Lateral radiograph of elbow showing avulsion fracture of the olecranon process with associated soft tissue swelling at posterior aspect of elbow

Sagittal T2 and PDFS images show complete avulsion tear with retraction of triceps tendon with avulsion fracture of the tip of olecranon process. Prominent edema and hyperintense signal is noted in visualized distal triceps muscle. There is moderate elbow joint effusion.There is swelling and edema of overlying subcutaneous tissues.

Case Discussion

Triceps tendon avulsion is one of the rare tendinous injuries and has been described as 'the least common of all tendon injuries'. Most of the injuries involve fall on the outstretched hand or sudden weight lifting or blunt trauma. Factors which weaken the tendon like olecranon bursitis or corticosteroid injection, increase the risk of a tear. Triceps tendon avulsion should be suspected in patients presenting with pain and swelling about the elbow after trauma as it may be overlooked during an initial assessment of trauma to the upper extremity, particularly when it is associated with other fractures of the wrist or proximal radius. 

On clinical examination there is tenderness and swelling overlying the olecranon process. There may be a palpable defect at the distal insertion site of triceps. Active extension is not possible and passive range of motions are restricted and painful. Ultrasound or MRI of the elbow are usually diagnostic.

In this case, a lateral radiograph of the elbow shows displaced avulsion fracture of the olecranon and associated soft tissue swelling, which raises a high suspicion of triceps tendon avulsion tear. MRI of the elbow clearly shows avulsion of the triceps tendon with retraction.

Early surgical repair is recommended for a good functional outcome.

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