Triceps Tendon Rupture

Triceps tendon rupture is a rare tear of the distal triceps tendon, usually an avulsion from the olecranon in a man in his 40s.

It usually follows a fall on an outstretched hand or a failed heavy press. In younger patients it is commonly linked to weight training and anabolic steroid use; in older patients, to chronic kidney disease, diabetes and corticosteroid exposure. Complete ruptures in active patients are usually repaired, because non-operative care often leaves extension weakness. Early specialist referral keeps straightforward primary repair possible.

The long, lateral and medial heads of triceps form a common tendon on the posterior olecranon. The long and lateral heads form a superficial tendinous layer; the medial head inserts deeper and more muscular. Partial tears usually involve the superficial layer and spare the deep medial head, so some extension is kept.

Triceps is the main elbow extensor, but anconeus and the lateral triceps expansion can still give weak extension. Extension against gravity therefore does not exclude a high-grade or even complete rupture.

Patterns and mechanism:

• •Complete rupture: usually avulsion at the bony insertion, often with a small olecranon flake
• •Partial rupture: usually the superficial layer
• •Mechanism: eccentric load on a contracting triceps in a fall on an outstretched hand, a failed heavy press, or less often a direct blow

Risk factors: anabolic steroid use, chronic kidney disease with secondary hyperparathyroidism, local corticosteroid injection around the insertion or olecranon bursa, systemic corticosteroids, diabetes, insertional tendinopathy and fluoroquinolone exposure.