TRICEPS INJURY-SOFTBALL PLAYER

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History: A 39-year-old softball player injured his right elbow playing softball. The injury occurred secondary to a fall with impact of his posterior elbow onto a hard object. He had immediate pain and swelling. He was seen in the emergency room one week later due to continued pain with increasing swelling over the back of his elbow as well as forearm and hand. A Doppler study was negative for a DVT. No x-rays were done. He was seen in out-patient follow-up one week later with primary complaints of pain, swelling, and weakness. He was unable to play softball, but otherwise was not limited by the injury. He denied any significant numbness or tingling. ROS negative for neck, shoulder or wrist pain. Physical Exam: generally well developed and muscular male in no distress. Right arm with swelling noted to involve upper arm, elbow, forearm and wrist. There was swelling of the olecranon bursa. There was a 2 × 3 cm mass present 3–4 cm proximal to the olecranon. There was associated tenderness over the bursa and mass. No increased skin temperature or errythema. ROM 0–140 degrees flexion, 90 degrees pronation and supination. (+) Pain with passive and active elbow flexion and extension. Strength 5/5 with flexion, 4/5 extension. Neurologic and vascular status intact with 2+ radial pulses. DIFFERENTIAL DIAGNOSIS: Traumatic bursitis with myositis ossificans Olecranon or occult fracture DVT Triceps tendon tear TEST AND RESULTS: Radigraphs Small area of calcification in triceps just proximal to the olecranon. No fracture or bony abnormalities present. DRAINAGE OF HEMATOMA: Sixty milliliters of serosanguineous fluid was removed with an 18 gauge needle. A palpable defect was present over the posterior olecranon with a palpable firm mass over distal/posterior arm. MRI: Sagital T1, T2, short tau inversion recovery (STIR) and axial images were performed. Pattern consistent with post-traumatic olecranon bursitis associated with edema and fluid within and adjacent to the triceps tendon and lateral triceps head suggesting of partial tear of the muscle fibers, and myositis. No fracture or bony abnormalities. FINAL/WORKING DIAGNOSIS: Triceps tendon tear TREATMENT AND OUTCOMES: Orthopedic referral Surgical repair of the triceps tendon with drill holes and suturing Cast Immobilization post-operatively for 3 weeks Early motion followed by strengthening Return to sports 4–6 months after repair