The Torn Triceps

updated on May 5, 2008 9:52 PM PDT

Portions taken from The Spanos Injury

MRI of a torn Triceps

This is one of those tricky injuries that happens and sometimes, as is the case with Matt Spanos, you are not quite sure how it happened. This is a fairly frequent injury in bodybuilding, but not in football, and the more sever injuries will require surgical intervention to be repaired. Injuries to the biceps and triceps tendons around the elbow are rare. They typically follow a history of trauma involving forceful eccentric contraction of the muscle and predictably result in weakness and pain. Conservative management of this injury is restricted to some partial tears and to those patients who may be unfit for surgery. Non-operative management of complete ruptures results in predictably poor results. So, an acute anatomic repair of these injuries is considered optimal. Delayed repair has been described using various grafts for augmentation with results that are good, but less predictable.

Another type of injury which could be a precursor to the triceps tear, is triceps tendonitis. Triceps tendonitis is a serious condition and can put you in a lot of pain and can limit your training capabilities. Symptoms include; pain around the lower part of the back of the arm, pain when you try to full straighten the arm or full bend the arm, bruising around the back of the arm near the elbow and swelling around the back of the elbow. Triceps tendonitis symptoms are reoccurring and will most often be felt every time you put excessive strain on the triceps. Diagnosing this injury is usually done by taking an x-ray to see if a chip off the bone may be causing the triceps tendonitis.

The injury is often confirmed by an MRI, as seen above, and it can also determine the severity of the injury and aid in the treatment of the injury.

Anterior/Posterior View of the Elbow
Photo Credit: The Hand University

About the Triceps

From Wikipedia

The triceps accounts for approximately 60 percent of the upper arm's muscle mass, but people who exercise the arms with weights often neglect this group of muscles in favor of the biceps brachii.

The triceps can be worked through either isolation elbow extension movements, contract statically to keep the arm straightened against resistance, or compound pressing movements.

Isolation movements include cable push-downs, "skull-crushers", and arm extensions behind the back.

Static contraction movements are pullovers, straight-arm pulldowns, and bent-over lateral raises, which are also used to build the rear deltoids and latissimus dorsi.

Examples of pressing movements are press ups, bench presses (level, incline or decline), military presses and dips. Using a closer grip stabilizes the arm allowing more weight to be used, so the triceps can be worked harder without being limited by the strength of the pectorals or shoulders.

Elbow extension is important to many athletic activities. As biceps are often worked more for aesthetic purposes, this is usually a mistake for fitness training. While it is important to maintain a balance between the biceps and triceps for postural & effective movement purposes, what the balance should be and how to measure it is a conflicted area. Pushing and pulling movements on the same plane are often used to measure this ratio.

An offensive or defensive line player needs the triceps to help push off the opposing player as he comes out of the crouch. Whether it is tendonitis or a tear the injured player will lose some of the strength needed to perform blocking duties on the field of play.

Tendons attach muscle to bone; the triceps tendon connects the large triceps muscle on the back of the arm with the ulna. It allows the elbow to straighten with force, such as when you perform a push-up or to push out as Spanos would do to block an opposing defender.

There is a great abstract of an article in The American Journal of Sports Medicine outlining the injury to the Triceps Tendon in Pro-Football players. (Abstract taken in its entirety)

The American Journal of Sports Medicine 32:431-434 (2004)
© 2004 American Orthopaedic Society for Sports Medicine

Triceps Tendon Ruptures in Professional Football Players

Scott D. Mair, MD^*^,, William M. Isbell, MD, Thomas J. Gill, MD, Theodore F. Schlegel, MD and Richard J. Hawkins, MD^%%%%

From the University of Kentucky Sports Medicine, Lexington, Kentucky, Massachusetts General Hospital, Boston, Massachusetts, Steadman Hawkins Clinic, Denver, Colorado, and ^%%%% Steadman Hawkins Clinic, Vail, Colorado

^* Address correspondence to Scott D. Mair, MD, University of Kentucky Sports Medicine, 740 South Limestone, K-401 Kentucky Clinic, Lexington, KY 40536-0284.

Medial/lateral View of the Elbow
Photo Credit: The Hand University

Background: Distal rupture of the triceps tendon is a rare injury, and treatment guidelines are not well established.

Hypothesis: Football players with triceps tendon ruptures will be able to return to their sport with minimal functional deficits.

Study Design: Uncontrolled retrospective review.

Methods: Twenty-one partial and complete ruptures of the triceps tendon were identified in 19 National Football League players over a period of 6 years. Team physicians retrospectively reviewed training room, clinical, and operative notes for each of these players.

Results: Most of the injured players were linemen. The most common mechanism of injury was an eccentric load to a contracting triceps. Seven players had prodromal symptoms prior to injury, and 5 had received a cortisone injection. Eleven elbows with complete tears underwent surgical repair. Of 10 players with partial tears, 6 healed without surgery. One player suffered a subsequent complete tear requiring surgery, and 3 with residual pain and weakness underwent surgical repair following the season. Two surgical complications occurred, both requiring a second operation. All of the players but 1 returned to play at least one season of professional football after their injury.

Conclusions: Partial triceps tendon ruptures can heal without functional deficit. Surgical repair for complete ruptures generally produces good functional results and allows return to play.

Triceps injury treatment

Here some common types of triceps injury treatment. Some severe triceps injuries cannot be cured.

* Using an ice-pack during resting periods.

* Anti-inflammatory medication.

* Brace/Strap - This may be used to wrap around the lower part of your triceps during activities that cause discomfort or pain. It works by taking the pressure off the tendon.

* Surgical treatment - surgery is only performed if the triceps tendon is ruptured, not for inflamation. Optimal surgical results are obtained within 14 days of the triceps tendonitis occurring.

* Tricep rehabilitation exercises.

Surgical Technique

This is a routine procedure as the same technique is used to fix Olecranon fractures.

A 13cm incision is made over the elbow joint and the proximal end of the ruptured or avulsed triceps tendon is identified. It usually includes a bony fragment and, if so, this is excised. A hole 3 mm in diameter is drilled transversely through the olecranon about 1 cm distal to its tip. A suture is then passed through the hole. This band, which will reinforce the suture, is brought proximally to lie beside the tendon at the level of the musculotendinous junction. It is threaded through a large needle and a loop is made through the tendon about two-thirds of the distance from the tip of the olecranon to the musculotendinous junction. The needle is then passed transversely through the tendon and another loop is fashioned.

The elbow is held in the extended position and tension is applied to the reinforcing band in order to bring the proximal end of the tendon close to the tip of the olecranon or to the distal end when this is present. The two ends of the band are tied together. The knot is secured with silk sutures. The proximal end of the divided tendon is then sutured to the distal end (or to the periosteum) with sutures. The torn musculotendinous junction on both sides also is sutured.