Triceps Rupture
Triceps Tendon Tear at the Elbow
A rare but significant injury - expert diagnosis and treatment
Understanding Triceps Rupture
Triceps tendon rupture is the least common of all tendon ruptures, accounting for less than 1% of upper extremity tendon injuries. The triceps is the primary elbow extensor, and complete rupture significantly impairs function.
Key Facts
- • Accounts for <1% of all tendon ruptures
- • Most occur at tendon-bone junction (olecranon)
- • Middle-aged males most commonly affected
- • Dominant arm usually involved
- • Associated with anabolic steroid use
Risk Factors
- • Anabolic steroid use (most common association)
- • Local corticosteroid injections
- • Chronic renal failure / dialysis
- • Hyperparathyroidism
- • Olecranon bursitis (weakens tendon)
- • Systemic lupus erythematosus
Presentation & Diagnosis
Mechanism & Symptoms
Clinical Tests & Imaging
Modified Thompson Test
Squeeze triceps muscle - no elbow extension if complete rupture
X-ray "Fleck Sign"
Small bony fragment avulsed from olecranon seen on lateral view
MRI
Gold standard - shows tear location, extent, and retraction
Ultrasound
Dynamic assessment, can show tendon discontinuity
Treatment Options
May be considered for:
- • Partial tears (<50%) with intact extension against gravity
- • Low-demand, elderly patients
- • Significant medical comorbidities
Protocol:
- • Splint at 30° flexion for 4-6 weeks
- • Progressive ROM and strengthening
- • Close monitoring for extension lag
Surgery is indicated for complete ruptures and partial tears in active individuals
Surgical Technique
- • Posterior midline incision
- • Identify and mobilize tendon ends
- • Debride degenerative tissue
- • Reattach to olecranon through bone tunnels or suture anchors
Fixation Methods
- • Transosseous tunnels: Traditional technique, strong fixation
- • Suture anchors: Less bone trauma, good fixation
- • Suture button: Emerging technique with good results
Chronic Ruptures
May require V-Y advancement, turndown flap (Anconeus), or allograft reconstruction
Recovery & Rehabilitation
Splint at 30-45° flexion
Avoid active extension
Gentle passive motion after 2 weeks
Active ROM exercises
No resistance initially
Progress flexion gradually
Progressive strengthening
Return to activities 4-6 months
Heavy lifting after 6 months
Expected Outcome: Good to excellent results in 85-90% of surgically repaired cases
Evidence & References
• Anzel SH, et al. Disruption of muscles and tendons: Analysis of 1,014 cases. Surgery 1959
• Mair SD, et al. Triceps tendon ruptures in professional football players. Am J Sports Med 2004
• van Riet RP, et al. Surgical treatment of distal triceps ruptures. J Bone Joint Surg Am 2003
• Yeh PC, et al. Triceps tendon repair with anchor sutures. Orthopedics 2010
Last Updated: January 2025 | Content reviewed by Dr. Deepthi Nandan Reddy, FRCS (Ortho)