The triceps muscle is a powerful extensor of the elbow
joint. The triceps muscle has three heads: the long head, the lateral head, and
the triceps. All three heads of the triceps muscle share a common tendon that
inserts into the olecranon process at the elbow. An injury to the triceps
tendon can be missed. Rupture of the triceps muscle typically occurs in male
athletes such as body builders, football players, and in athletes who lift
heavy weights. The injury can also occur due to a fall onto an outstretched
hand. The tear is usually seen in middle aged men. A rupture of the tendon can
be either complete, or incomplete. The rupture occurs at the bony insertion of
the tendon. The patient may have pain, swelling, and some ecchymosis around the
posterior part of the elbow. Mechanisms of injury include stress from sudden
increase in intensity of training, direct trauma to the tendon, and laceration
of the tendon. Rupture of the tendon may also occur due to local steroid
injection or it may be due to t a history of anabolic steroid use. Rupture may
also occur due to systemic diseases such as renal disease, gout, or it may
occur due to previous elbow surgery. Other risk factors include use of cipro
(ciprofloxacin), diabetes mellitus, rheumatoid arthritis, osteoarthritis, and
olecranon bursitis. There will be painful limitation of range of motion and the
patient will not be able to extend the elbow against resistance. The patient
may hear a “pop” and the tendon may retract upwards. A gap may be felt in the
back of the elbow where the rupture occurs. There is a squeeze test for the
distal biceps injury, achilles tendon injury, and also a squeeze test for the
triceps injury. This test is completed when the patient is laying prone. The
forearm will be hanging down with the elbow at the edge of the table and then
squeeze the triceps. The inability of the patient to extend the elbow against
gravity means that the patient has a complete tear of the triceps. X-rays may
show a small bony avulsion. The “flake” sign identifies the avulsion and the
position of the tendon on a lateral x-ray.
