Triceps Tendon Avulsion Clinical Presentation

Updated: Oct 09, 2019
  • Author: Bhavuk Garg, MBBS, MS, MRCS; Chief Editor: Harris Gellman, MD  more...
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Presentation

History and Physical Examination

The diagnosis of triceps tendon avulsion is usually evident in patients who present with a characteristic history. The presence of a palpable gap in the posterior elbow is a more valuable symptom than loss of active elbow extension in the diagnosis of triceps tendon avulsion. [17]

Clinical features include pain and swelling of the posterior part of the elbow. A palpable depression just proximal to the olecranon may be noted on physical examination. [5, 6] These findings may be difficult to appreciate in the setting of severe pain and swelling, especially if they are present in a muscular athlete with large bulk. [4, 6] Ecchymosis may be marked several days, but not immediately, after injury.

The physician who is diagnosing an avulsion of the triceps tendon must determine whether the tear is complete or partial. To this end, careful testing of extension strength of the elbow is needed for guidance of therapeutic management. The literature suggests that a substantial loss of elbow motion and triceps power reflects a complete tear that is unlikely to improve with nonsurgical management. [18] Therefore, any nonsurgical approach to management should include close follow-up.

Variations in clinical symptoms and signs after incomplete or complete avulsions of the triceps may delay correct diagnosis. Patients with rupture of the triceps tendon may present with cubital tunnel syndrome, [19] a snapping elbow, [20] collar stud–shaped olecranon bursitis, [21] or even posterior compartment syndrome. [22] Associated injuries include radial head-neck fractures and fractures of the wrist. [5, 17]

In the treatment of apparently isolated capitellum fractures, surgeons should consider the possibility of a triceps avulsion injury. If there is a fleck sign on the lateral radiograph with suspicion of an avulsion fragment from the olecranon, the triceps mechanism should be explored as part of the extensile lateral approach in the treatment of these complex injuries. [23]