Triceps Tendon Rupture Research Articles

Modified posterior approach for total elbow replacement.

Surgical exposure for total elbow replacement should provide complete visualization of the joint surfaces. The soft tissue reconstruction following replacement often requires protection and can lead to complications such as triceps tendon rupture. We describe a modification of the posterior approach to the elbow that provides optimal exposure and allows early mobilization.

Endoscopic Repair of Tears of the Superficial Layer of the Distal Triceps Tendon

The purpose of this study was to evaluate the results after endoscopic repair of partial superficial layer triceps tendon tears. Fourteen patients treated surgically between July 2005 and December 2012 were studied prospectively for 12 months. Indication for surgery was a partial detachment of the triceps tendon from the olecranon that was proved by magnetic resonance imaging (MRI) in all cases. Ten of these patients had chronic olecranon bursitis. All patients were treated with endoscopic surgery including bursectomy and repair of the distal triceps tendon with double-loaded suture anchors. Clinical examination of the patients as well as functional and subjective scores (Mayo Elbow Performance Index [MEPI], Disabilities of the Arm, Shoulder and Hand Score [Quick DASH]) were obtained preoperatively and postoperatively at 6 and 12 months. An isokinetic strength measurement and MRI were performed preoperatively and 12 months after surgery. All 14 patients were completely evaluated. The MEPI and Quick DASH Score improved significantly after the repair at all postoperative examinations. The MEPI gained 29 points, up to 96 points at last follow-up (P < .05), and the Quick DASH Score went down 15.6 points after 12 months to 4.5 points (P < .05). Maximum extension power improved 55.8%, up to 94.7% at last follow-up compared with the contralateral side. UsingMRI, we found one reruptured partial tear of the triceps tendon that did not require revision surgery. Although triceps tendon ruptures are generally uncommon, partial superficial tears might be more common than previously described. Once the diagnosis is made, endoscopic repair is a method leading to good clinical results with improved function of the affected elbow. Endoscopic repair of superficial tears of the triceps tendon is able to restore function and strength and leads to excellent clinical results after 1 year. Strength recovers to nearly that of the contralateral side, and serious complications appear to be infrequent. Level IV, therapeutic case series.

Synthetic Augmented Suture Anchor Reconstruction for a Complete Traumatic Distal Triceps Tendon Rupture in a Male Professional Bodybuilder with Postoperative Biomechanical Assessment

Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the “off-season” and “precompetition” phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports.

Anatomical Distal Biceps and Triceps Tendon Repairs

Distal biceps and triceps tendon ruptures are amongst some of the most important tendon ruptures encountered by the orthopaedic surgeon. Recent clinical and basic science studies have improved our understanding of both these injuries. In contrary to classical thinking, the distal biceps tendon appears to remain as 2 distinct anatomical and physiological tendons. The short head subunit of the distal biceps tendon inserts further distal and anterior on the radial tuberosity and functions as the more efficient elbow flexor. In comparison, the long head inserts more proximal and posterior as it wraps around the tuberosity. This distinct insertion site positions the long head subunit in a way that allows it to be the more efficient supinator of the 2 as the forearm is supinated. To closely replicate native anatomy and function, surgical repair of the ruptured distal biceps tendon should restore both unique footprints of the distal short and long head tendons, the “dual-head” repair. The native triceps tendon encompasses a broad insertion site along the proximal ulna; it also expands laterally as it incorporates into the anconeus. This allows an expansive transmission of force for elbow-extension power. A “dual-row” triceps tendon repair closely duplicates this broad native footprint and contact area in attempts to better restore elbow function. This article discusses modern anatomical-based techniques for surgical repair of both the distal biceps and triceps tendons.

Diagnosis of triceps tendon rupture with bedside ultrasonography

Emergency Medicine AustralasiaVolume 25, Issue 5 p. 475-476 Case Letter Diagnosis of triceps tendon rupture with bedside ultrasonography Murat Yesilaras, Murat Yesilaras Department of Emergency Medicine, Izmir Tepecik Training and Research Hospital, Izmir, TurkeySearch for more papers by this authorErsin Aksay, Ersin Aksay Department of Emergency Medicine, Izmir Tepecik Training and Research Hospital, Izmir, TurkeySearch for more papers by this author Murat Yesilaras, Murat Yesilaras Department of Emergency Medicine, Izmir Tepecik Training and Research Hospital, Izmir, TurkeySearch for more papers by this authorErsin Aksay, Ersin Aksay Department of Emergency Medicine, Izmir Tepecik Training and Research Hospital, Izmir, TurkeySearch for more papers by this author First published: 06 October 2013 https://doi.org/10.1111/1742-6723.12094Citations: 4Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume25, Issue5October 2013Pages 475-476 RelatedInformation

Bilateral Scapular Fracture and Triceps Tendon Rupture After a Grand Mal Seizure: A Case Report.

We report a case of bilateral and simultaneous triceps tendon rupture and scapular fracture (Orthopaedic Trauma Association [OTA] classification 14-A3.2) after a single generalized tonic-clonic seizure. To the best of our knowledge, the current literature reports only three cases of bilateral complete triceps tendon rupture in hemodialysis patients1-3 and one case of bilateral partial triceps tendon rupture in an athlete4. Scapular fractures are most commonly caused by high-energy trauma, electric shock, or convulsions5-7, and there are several published cases of bilateral scapular fracture secondary to seizure activity6,8,9. Our case emphasizes the importance of recognizing renal osteodystrophy and secondary hyperparathyroidism as common underlying conditions leading to orthopaedic injuries. The patient was informed that data concerning the case would be submitted for publication, and he provided consent. A forty-two-year-old left-hand-dominant man was admitted to the intensive care unit with profound hyponatremia after a witnessed, single, generalized tonic-clonic seizure following a missed dialysis appointment. The chief symptom was bilateral upper-extremity weakness and limited shoulder motion, which occurred immediately after the seizure. Past medical history was notable for hypertension, gout, and polycystic kidney disease with chronic renal failure that required hemodialysis. Medication included 2000 mg of calcium acetate three times per day for hyperphosphatemia. One week prior to the seizure, the patient had hypocalcemia (calcium, 6.0 mg/dL) and hyperphosphatemia (phosphate, 8.9 mg/dL), and two weeks prior to the seizure, the parathyroid hormone level was 1900 pg/mL. The laboratory values on admission are listed in Table I; hyponatremia, hypocalcemia, and hyperphosphatemia were all present. View this table: TABLE I Vital Signs and Laboratory Values on Admission Radiographs and computed tomography (CT) of both shoulders (Figs. 1 and 2), with axial and coronal reconstructions, demonstrated comminuted fractures of the scapulae inferior to the glenoid (OTA …

Distal biceps and triceps ruptures

Biceps and triceps tendon ruptures are rather uncommon injuries and are most commonly diagnosed clinically. Magnetic resonance imaging can help the clinician to differentiate an incomplete tear and define any degeneration of the tendon. Surgical anatomical repair is typically performed in acute complete ruptures whereas nonoperative treatment can be used for partial ruptures, as well as for patients unfit for surgery. Single incision techniques are associated with a higher rate of nerve injuries, while double incision repairs have a higher prevalence of heterotopic ossification. Although various fixation methods have been applied including bone tunnels, interference screws, suture anchors, cortical button fixation, the current evidence does not support the superiority of one method over the other. A well-planned postoperative rehabilitation programme is essential for a good final outcome. As better fixation devices are being used, more aggressive rehabilitation programmes have been applied. Epidemiology, clinical evaluation, diagnosis, surgical and conservative management of these injuries are presented in this review along with the authors’ preferred technique for the anatomical repair of acute complete ruptures.

Triceps Tendon Reconstruction Using Ipsilateral Palmaris Longus Autograft in Unrecognized Chronic Tears

Injury to the distal triceps tendon is uncommon and can be difficult to diagnose, especially when a partial rupture or tear occurs. In situations where an incomplete disruption to the musculotendinous unit occurs, a palpable defect or clear functional loss may not be present. Advanced imaging techniques, such as magnetic resonance imaging or ultrasound, can be used to confirm the diagnosis and define the extent of injury. The treatment of a complete rupture of the distal triceps tendon is repair or reconstruction, whereas the management of a patient with a partial triceps rupture is related to the pain, functional deficit, and expectations of the patient. This article presents 2 patients with chronic, near complete disruptions of the distal triceps tendon. In both patients, surgical reconstruction of the injured tendon was accomplished using ipsilateral palmaris longus autograft. This technique allows the treating surgeon to harvest the graft from the ipsilateral upper extremity. The palmaris autograft is then used to reconstruct the injured portion of the triceps tendon using a Pulvertaft weave technique through the intact triceps tendon and osseous tunnels within the proximal ulna. This technique allows for easy surgical setup and harvest of autograft tendon and provides a structurally sound technique for a tension-free reconstruction of the injured tendon. It also permits early postoperative elbow range of motion, with active elbow extension allowed at 6 weeks. The authors have used this technique successfully in the treatment of chronic partial tears of the distal triceps tendon.

Triceps Rupture: A Case Series, Anatomical Study of the Triceps Footprint and Description of Surgical Technique

BackgroundDistal triceps tendon ruptures are rare accounting for less than 1% of all tendinous injuries in the upper extremity. Such injuries should be suspected in patients who have pain about the elbow following an eccentric contraction to the upper extremity. Complete ruptures should be treated with early surgical repair with reattachment of the tendon to the olecranon. Most reports to date have used suture fixation through olecranon drill holes. This study was performed to asses the anatomy of the triceps insertion and it's implications on the adequate fixation of the triceps tendon using a novel technique.MethodsTen cadaveric adult upper extremities with no signs of prior trauma or surgery were used in this study. The specimens were stripped of all skin and subcutaneous tissue through a direct posterior approach, to identify the triceps insertion. The insertion of the triceps tendon was then mapped and the area of the medial, long and lateral heads measured. Three cases of distal triceps rupture using this new open repair technique are also described using two distal drill holes and sutures augmented with a proximal anchor. Two of the three patients also needed LARS ligament augmentation at the time of surgery due to tissue loss.ResultsIn all cadaveric sections separate insertions were found consisting of the medial head and the conjoint tendons of the long and lateral heads. The mean surface areas for the medial and long/lateral insertions were 100.4 mm2and 307.9 mm2respectively. The mean total area for the triceps insertion was found to be 408.3 mm2. At follow up all cases were assessed using the Oxford Elbow Score, Mayo Elbow Performance Scores and Disabilities of the Arm, Shoulder and Hand Scores.ConclusionsWe have shown that the insertion of the triceps tendon is a “footprint” made from the tendon of the medial head and a conjoint tendon of the long and lateral heads. For cases of distal triceps rupture we have described an open procedure using a “double row footprint reconstruction” technique which we believe anatomically reconstructs the triceps insertion.

Triceps tendon avulsion: a case report and discussion about the olecranon ossification nucleus

Rupture of the triceps tendon is a rare condition. We report a case of triceps tendon rupture with avulsion fracture of the olecranon with discussion about pathogenesis from the viewpoint of healing of the olecranon ossification nucleus. An 18-year-old man presented with avulsion fracture of the olecranon and triceps tendon rupture. Operative treatment was conducted with good results. Rupture of the triceps tendon is a rare injury comprising approximately 2% of all tendon injuries, and avulsion at insertion into the olecranon is the most common site of rupture. This injury is most likely to happen in young people as sports-related trauma. Among young people who have insufficient healing of the olecranon ossification nucleus, avulsion fracture of the olecranon may occur due to strong contraction force of the triceps tendon. Our clinical evidence may suggest that avulsion fracture of the olecranon is related in olecranon ossification center healing. Most triceps tendon ruptures are accompanied by avulsion fracture of the olecranon, and it is important to suspect this injury when radiographs show a small fleck of bone avulsed from the olecranon.

Evaluation and Management of Elbow Tendinopathy

Context:Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations.Evidence Acquisitions:The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy.Results:Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments.Conclusions:Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury.

Rupture partielle distale du tendon du triceps brachial chez le sujet sportif

Distal brachii triceps tendon rupture is rare. Partial lesions are not so well defined. If functionally they are well tolerated in patients with low functional demand, management guideline is not so clear for sportsmen. To our best knowledge, there is no reported technique for the repair of partial forms. A 28 year-old patient was operated on for a partial triceps rupture. He underwent a transosseous olecranon suture of the tricipital tendon, with a side-to-side suture to the healthy residual tendon. The patient was assessed at 2 years follow-up with the DASH score. He had painless and mobile elbow with no effusion and returned to sport 4 months after his surgical repair. The extension strength was comparable to the healthy side (5/5). The DASH score was 1.7 for global score, and 6.3 for work and sport modules. Partial rupture of brachii triceps tendon is not well tolerated in high functional demand patients. We think that patients should be operated in these situations and may achieve excellent results. Postoperative management is crucial to achieve good results as well as in complete rupture.

Clinical Outcome After Suture Anchor Repair for Complete Traumatic Rupture of the Distal Triceps Tendon

To evaluate the clinical results of surgical repair of complete distal triceps tendon rupture using suture anchors and high-strength sutures by use of validated outcome measures. A consecutive series of traumatic distal triceps tendon ruptures at a single institution were studied. All cases were surgically repaired by use of suture anchors double loaded with ultrahigh-molecular-weight polyethylene-containing sutures. All patients were evaluated with a physical examination, radiographs, and questionnaires. The following postoperative validated outcome measures were used: the Disabilities of the Arm, Shoulder and Hand (DASH) score; the Oxford Elbow Score; the American Shoulder and Elbow Surgeons elbow assessment form; and the Mayo Elbow Performance Index. Five male patients with a mean follow-up of 32 months underwent suture anchor repair for traumatic rupture of the distal triceps tendon. Of the repairs, 3 were in the dominant arm and 2 in the nondominant arm. The mean patient age was 47 years (range, 35 to 54 years). Postoperatively, the mean DASH score was 1.4, the mean American Shoulder and Elbow Surgeons elbow score was 99.2, the mean Mayo Elbow Performance Index was 95.8, the mean Oxford Elbow Score for pain was 98.8, the mean Oxford Elbow Score for function was 100, and the mean Oxford Elbow Score for the social domain was 96.2. A lower score for the DASH indicates less disability and better function. This retrospective case series of suture anchor repair of distal triceps tendon ruptures showed excellent elbow function based on validated clinical outcome measures. Level IV, therapeutic case series.

Clinical Outcome Measures Following Suture Anchor Repair for Traumatic Rupture of the Distal Triceps Tendon (SS-53)

Introduction Rupture of the triceps tendon is an uncommon injury with few published reports of surgical repairs. These publications include case reports and small series, which assess elbow strength and motion, but fail to report any commonly used or validated elbow outcome measures for the patients. These reports all utilize braided polyester sutures through bone tunnels in the olecranon for the reattachment of the distal triceps tendon. While recent publications have described the surgical technique and biomechanical properties of distal triceps tendon repair using suture anchors, there are no published outcomes using this technique. The purpose of this study is to report the clinical outcomes following suture anchor repair of the ruptured triceps tendon with high strength sutures. An extensive literature review failed to identify any other report which evaluated the clinical results using validated elbow outcome measures or to report the clinical results following distal triceps suture anchor repair. Methods A consecutive series of traumatic distal triceps tendon ruptures from a single institution between 2006 and 2010 was reviewed. All cases were surgically repaired using suture anchors and high strength sutures. The patients were evaluated postoperatively using the Disabilities of the Arm, Shoulder, and Hand (DASH) outcome measure, the Oxford Elbow Score, the American Shoulder and Elbow Surgeons (ASES) elbow assessment form, and the Mayo Elbow Performance index. Results A total of five male patients with at least six months follow-up underwent suture anchor repair for traumatic rupture of the distal triceps tendon. Of the five distal triceps tendon tears, three involved the dominant arm and two involved the non-dominant arm. The average patient age was 46.8 years (range, 35 to 54) and the average follow-up was 27.4 months (range 6 to 49 months). Postoperatively, the mean DASH score was 2.2 (from 0-100, lower score indicates less disability and better function), the mean ASES elbow score was 99.2 (from 0-100, higher score indicates better outcome), the mean Mayo Elbow Performance Index was 95.8 (from 0-100, higher score indicates better outcome), the mean Oxford Elbow Pain Score was 98.8 (from 0-100, higher score indicates less pain and better outcome), the mean Oxford Elbow Function Score was 100 (from 0-100, higher score indicates better function), and the mean Oxford Elbow Social Score was 96.2 (from 0-100, higher score indicates better outcome). Conclusion Distal triceps tendon ruptures can be successfully repaired using high strength sutures in suture anchors instead of conventional sutures in bone tunnels. This technique results in minimal pain and excellent elbow function based on validated clinical outcome measures.

Ultrasound demonstration of distal triceps tendon tears

Rupture of the distal triceps tendon is an uncommon injury that may be unrecognized on clinical examination. The purpose of the study is to describe the role of US in distal triceps tendon tears evaluation. IRB approval was obtained and patients gave written informed consent. Of 77 consecutive US examinations of the elbow obtained over a five-year period, eight patients with correlative MR and surgery available were identified having partial or complete distal triceps tendon tear. N = 4 complete tears of the triceps tendon and n = 4 partial tears of the distal triceps involving the lateral/superficial head were identified. Patients with partial tear had a history of a single traumatic event that determined a sudden eccentric contraction of the triceps muscle against resistance. US demonstrated on axial and longitudinal planes a partial tear of the triceps brachii tendon that resulted in a fusiform swelling and retraction of the lateral/superficial head in four patients. It was possible to identify the normal insertion of the medial head of the triceps moving the transducer medially. MR and surgical findings were concordant with US findings in every patient. Ultrasound is able to differentiate complete from partial triceps tendon tears. US has the potential to identify isolated lesions of the lateral/superficial head of the triceps with an intact medial head.

Avulsion of the distal triceps tendon with fracture of the radial head

We present a rare case of associated distal triceps tendon avulsion with radial head fracture; the lateral and medial collateral ligaments of the elbow were also ruptured. The patient underwent surgical procedure for the reinsertion of the triceps tendon using metallic anchors, radial head prosthetic replacement, and repair of the lateral collateral ligament. We believe this combined injury pattern of radial head fracture with triceps tendon rupture or avulsion should be considered according to the concept of the spectrum of elbow instability.

Triceps tendon rupture with avulsion fracture of the olecranon in a rugby football player&#151;A case report&#151;

Triceps tendon rupture with avulsion fracture of the olecranon in a rugby football player&#151;A case report&#151;

The Distal Triceps Tendon Footprint and a Biomechanical Analysis of 3 Repair Techniques

Background Anatomic repair of tendon ruptures is an important goal of surgical treatment. There are limited data on the triceps brachii insertion, footprint, and anatomic reconstruction of the distal triceps tendon. Hypothesis An anatomic repair of distal triceps tendon ruptures more closely imitates the preinjury anatomy and may result in a more durable repair. Study Design Descriptive and controlled laboratory studies. Methods The triceps tendon footprint was measured in 27 cadaveric elbows, and a distal tendon rupture was created. Elbows were randomly assigned to 1 of 3 repair groups: cruciate repair group, suture anchor group, and anatomic repair group. Biomechanical measurement of load at yield and peak load were measured. Cyclic loading was performed for a total of 1500 cycles and displacement measured. Results The average bony footprint of the triceps tendon was 466 mm2. Cyclic loading of tendons from the 3 repair types demonstrated that the anatomic repair produced the least amount of displacement when compared with the other repair types (P < .05). Load at yield and peak load were similar for all repair types (P > .05). Conclusion The triceps bony footprint is a large area on the olecranon that should be considered when repairing distal triceps tendon ruptures. Anatomic repair of triceps tendon ruptures demonstrated the most anatomic restoration of distal triceps ruptures and showed statistically significantly less repair-site motion when cyclically loaded. Clinical Relevance Anatomic repair better restores preinjury anatomy compared with other types of repairs and demonstrates less repair-site motion, which may play a role in early postoperative management.

Combined surgical treatment for missed rupture of triceps tendon associated with avulsion of the ulnar collateral ligament and flexor-pronator muscle mass

Triceps tendon ruptures are rare injuries. Coexistence of ipsilateral ulnar collateral ligament injury is even rarer. Here, we describe an unusual combination injury to elbow of a 39-year-old male construction worker consisting of triceps tendon rupture, avulsion of elbow ulnar collateral ligament and flexor pronator muscle origin ipsilaterally. A simultaneous repair and reconstruction of all damaged structures was proposed with individualized postoperative rehabilitation. Return to pre-injury level of activities obtained with this treatment protocol. High degree of suspicion and careful examination were needed to prevent missed diagnosis and prolonged instability which may be inevitable after inappropriate treatment of such injury.

Elbow Tendinopathy and Tendon Ruptures: Epicondylitis, Biceps and Triceps Ruptures

Lateral and medial epicondylitis are common causes of elbow pain in the general population, with the lateral variety being more common than the medial by a ratio reportedly ranging from 4:1 to 7:1. Initially thought to be an inflammatory condition, epicondylitis has ultimately been shown to result from tendinous microtearing followed by an incomplete reparative response. Numerous nonoperative and operative treatment options have been employed in the treatment of epicondylitis, without the emergence of a single, consistent, universally accepted treatment protocol. Tendon ruptures about the elbow are much less frequent, but result in more significant disability and loss of function. Distal biceps tendon ruptures typically occur in middle-aged males as a result of an event that causes a sudden, eccentric contraction of the biceps. Triceps tendon ruptures are exceedingly rare but usually have a similar etiology with a forceful eccentric contraction of the triceps that causes avulsion of the tendon from the olecranon. The diagnosis of these injuries is not always readily made. Complete ruptures of the biceps or triceps tendons have traditionally been treated surgically with good results. With regard to biceps ruptures, there continues to be debate about the best surgical approach, as well as the best method of fixation of tendon to bone. This article is not meant to be an exhaustive review of the broad topics of elbow tendinopathy and tendon ruptures, but rather is a review of recently published information on the topics that will assist the clinician in diagnosis and management of these conditions.