TRICEPS RUPTURE IN A RUGBY PLAYER 616

Abstract

HISTORY: A 35 y/o rugby player was pulling down with his left arm during a scrum, when he felt a tear and a pop in his left elbow. He finished the game, although he experienced increased weakness in the arm. Following the game, he noticed a severe contusion on his forearm. He played rugby the following weekend, but had difficulty due to weakness. There was no numbness or tingling in the extremity. He presented for care 10 days after the initial injury with pain, swelling and ecchymosis over the left arm and elbow region. PHYSICAL EXAM: Left arm with the large dorsal area of ecchymosis. Tender to palpation over the distal dorsal left arm. Palpable small step off over the area of the triceps insertion which is tender to palpation. Full range of motion. Normal elbow flexion, forearm supination and pronation. Decreased strength to resisted elbow extension, especially if he initiates contraction in full flexion. Strength in biceps 5/5, triceps 3+/5. Elbow was stable to varus and valgus stress. Sensation intact. TRICEPS RUPTURE IN A RUGBY PLAYER Mark W. Niedfeldt, M.D., Craig C. Young, M.D., William G. Raasch, M.D. Departments of Orthopaedic Surgery and Family and Community Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin DIFFERENTIAL DIAGNOSIS: Triceps Tendon Rupture Olecranon Fracture Loose Body Triceps Tendinitis Olecranon Bursa Rupture Ulnar Nerve Subluxation Myositis Ossificans Traumaticus TESTS AND RESULTS: Plain radiographs: Small secondary ossicle in the elbow joint MRI: Complete tear of the triceps tendon with retraction and proximal muscle edema/contusion FINAL/WORKING DIAGNOSIS: Partial triceps tendon rupture TREATMENT AND COURSE: At follow-up one week after the initial visit, the patient's triceps strength was much improved to 4+/5. He was performing low weight, high repetition resistance exercises on a triceps machine. Due to this improvement, surgical intervention was deferred. Three weeks later his strength continued to improve.