IS Case 417: Triceps tendon tear
Imaging Sciences URMC 2010
Publication Date: 2010-08-27
History
A 48-year-old male injured his right arm during heavy lifting.
Findings
Lateral radiograph of the right elbow (Fig. 1) shows posterior soft tissue swelling with small ossific fragments posterior to the elbow. Sagittal and coronal T2-weighted fat suppressed MRI images (Figs. 2 and 3) show full thickness tear of the triceps tendon at its insertion on the olecranon with proximal retraction. This is associated with diffuse edema in the dorsal superficial soft tissues.
Diagnosis
Triceps tendon tear
Discussion
Triceps tendon injury is thought to be the rarest of all tendon injuries. There is a 2:1 male predominance. Mechanisms of injury include a traumatic fall on an outstretched hand, direct trauma, motor vehicle accidents and power lifting.
The diagnosis is usually made clinically. The physical exam findings include tenderness, swelling, ecchymosis and a depression proximal to the olecranon. Absent active extension against resistance can be seen with a complete tear while diminished extension against resistance is seen with partial tears.
For suspected triceps tendon ruptures, radiographs should be obtained. They are helpful to confirm the presence of a tendon avulsion and to assess for concomitant injuries such as radial head fractures. In ambiguous cases, MRI or ultrasound can be used for further evaluation.
MRI is particularly useful in differentiating a complete versus partial tear and the amount of retraction of a completely torn tendon. The sagittal plane is best for visualizing the triceps tendon. A partial tear is characterized by a small fluid-filled defect within the distal triceps tendon with surrounding subcutaneous edema. A compete rupture is characterized by a large fluid-filled gap between the distal triceps tendon and the olecranon process and a large amount of surrounding subcutaneous edema.
The treatment of choice for almost all complete triceps tendon ruptures is acute operative repair, usually within the first 2 weeks after injury if possible.
References
- Vidal AF, Drakos MC, Allen AA. Biceps tendon and triceps tendon injuries. Clin Sports Med. 2004 Oct;23(4):707-22, xi. PMID: 15474231
- Tuite MJ, Kijowski R. Sports-related injuries of the elbow: an approach to MRI interpretation. Clin Sports Med. 2006 Jul;25(3):387-408, v. PMID: 16798134 [PubMed]
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