Elbow - Distal Bicep Tendon Tear
Description
A triceps rupture occurs when the triceps tendon tears away from its attachment to the olecranon, a bone in the forearm. The triceps tendon is responsible for turning and extending the elbow. Unlike the shoulder, there is only one attachment site for the triceps tendon in the forearm. Therefore, patients with triceps ruptures will have significant loss of strength in extending the elbow.
What are the causes?
Triceps ruptures generally result from falls. Tendonitis, or inflammation of the portion of the muscle which attaches to the bone, may precede the rupture.
What are the symptoms?
With triceps ruptures, patients often feel a 'pop' on the back of the elbow, followed by immediate pain and swelling. A bruise forms over the lower arm and elbow. There will be an immediate loss of strength. When the swelling subsides, a deformity will be present in the arm. Because the triceps muscle is under tension, it will retract up into the arm if its distal attachment ruptures. This causes the muscle to appear hollowed out in the lower part of arm, and balled up on the back of the arm.
How is it diagnosed?
Dr. Liu will perform a thorough history and physical exam with X-rays. A deformity is present and there is significant loss of motion and strength. X-rays are typically normal. MRI is helpful in confirming the diagnosis.
Non-operative
Partial thickness triceps tendon tears can be treated non-operatively. Your surgeon may recommend a sling for comfort, medication, physical therapy, cryotherapy and activity modification to reduce the pain and inflammation. Non-operative treatment of triceps ruptures is not recommended because of the loss of function.
Platelet Rich Plasma (PRP) Injections is another non operative option for partial thickness tears. Blood is taken from your arm and is spun down to get the healthiest healing factors - platelets and serum. Once injected, the platelets degranulate and release activate growth factors and cytokines to promote healing. A one time leukocyte rich, concentrated PRP injection is recommended. One injection may be all you need, however, there are times where multiple injections may provide additional benefit. Not covered by insurance.
Mesenchymal Stem Cell Injections is another non operative option, for partial thickness tears. Bone marrow is aspirated from your pelvis and centrifuged in a special kit to concentrate the stem cells, which are then reinjected into the tendon. The goals are to change the living microenvironment of the tendon, up regulating collagen formation, and promote tendon cell healing and reorganization. Not covered by insurance.
Operative
Operative repair is recommended for all triceps ruptures. This is completed through an incision on the back of the elbow. Multiple techniques exist for repairing the triceps back to the olecranon bone, including sutures, anchors and/or screws. Postoperative medication and physical therapy is at your surgeon’s discretion.
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