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Triceps Repair

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Elbow and Sport

Abstract

Triceps tendon tear is an uncommon injury. Rupture is frequently associated with preexisting systemic conditions or drug treatments, such as the local or systemic use of steroids. Patients are usually men taking part in sports activities between 30 and 50 years of age. Injury is typically caused by falling on an outstretched hand, a direct trauma on the elbow, or heavy lifting against resistance. The examination may reveal pain, a palpable tendon gap, and extension weakness, whereas a pathognomonic flake sign may be detected on radiographs. Magnetic resonance imaging is considered to be the gold standard to assess the size and extension of the tear: triceps lesions often occur at the tendon insertion, determining either partial or total tears.

Partial tears may be addressed by means of conservative treatment, with patients normally being able to return to sports activities after 4–6 months, when symptoms have resolved and strength is almost normal. However, the patient needs to be followed up closely during this period to ensure that the lesion does not worsen evolving into a complete one.

Primary repair of complete triceps injury is usually performed as soon as possible to ensure recovery of daily functions and sports activity, respectively, 3 and 5 months postoperatively while minimizing the risk of re-rupture. Postoperative care consists of elbow immobilization for 3–4 weeks, followed by flexion block bracing for a further 2–3 weeks. Full flexion and active extension are usually started 6–8 weeks postoperatively. The recovery of extension strength against resistance starts after 12 weeks, whereas unrestricted activity follows after 5–6 months.

Delayed diagnosis and treatment may complicate primary repair and result in the need for reconstructive procedures. Reconstruction of small defects using the anconeus rotation procedure provides full ROM and long-term strength. Chronic cases with large tendon gaps require instead using an allograft (Achilles tendon or hamstring). In such cases, a longer rehabilitation period is expected and only partial strength recovery may be achieved. In augmentation procedures, the postoperative protocol is the same as that for primary repair, though all the steps are delayed by 2–3 weeks.

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Authors and Affiliations

  1. Orthopedics and Traumatology, “Sapienza” University of Rome, Rome, Italy

    Giuseppe Giannicola MD, PhD, Gianluca Bullitta MD, Federico Maria Sacchetti MD & Marco Scacchi MD

  2. Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica –AUSL della Romagna Ambito Territoriale di Rimini, Cattolica, Italy

    Giovanni Merolla & Giuseppe Porcellini

Authors
  1. Giuseppe Giannicola MD, PhD
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  2. Gianluca Bullitta MD
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  3. Federico Maria Sacchetti MD
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  4. Marco Scacchi MD
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  5. Giovanni Merolla
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  6. Giuseppe Porcellini
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Corresponding author

Correspondence to Giuseppe Giannicola MD, PhD .

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Editors and Affiliations

  1. Nuovo Ospedale di Sassuolo, Sassuolo, Italy

    Luigi Adriano Pederzini

  2. Dept of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands

    Denise Eygendaal

  3. Istituto Clinico Humanitas, Rozzano, Milan, Italy

    Matteo Denti

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Giannicola, G., Bullitta, G., Sacchetti, F.M., Scacchi, M., Merolla, G., Porcellini, G. (2016). Triceps Repair. In: Pederzini, L., Eygendaal, D., Denti, M. (eds) Elbow and Sport. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-48742-6_15

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  • DOI: https://doi.org/10.1007/978-3-662-48742-6_15

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