Triceps Tendon Avulsion Workup

Updated: Sep 13, 2023
  • Author: Bhavuk Garg, MBBS, MS, MRCS(Ortho); Chief Editor: Harris Gellman, MD  more...
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Laboratory Studies

Laboratory investigations are noncontributory. However, they may help in diagnosing associated conditions, such as chronic renal failure, if such conditions are suspected.


Imaging Studies

Radiography remains the initial imaging modality of choice for evaluating a suspected triceps injury. Regarding diagnostic studies, radiography should be performed in all suspected cases of triceps tendon avulsion. Of the cases reported in the literature, avulsed flecks of bone from the olecranon were demonstrated in approximately 83%. [10, 4, 5] Careful inspection of all radiographs is crucial. If necessary, oblique views of the elbow should be obtained to rule out other fractures.

Lateral radiographs of the elbow are particularly useful for diagnostic confirmation. In Tarsney's study of seven cases of triceps tendon avulsion, lateral radiographs demonstrated bone fragments behind the distal humerus and just proximal to the olecranon in six cases. [5]

Levy et al reported their experience with 16 patients who had concomitant triceps ruptures and fractures of the radial head and noted that triceps ruptures may be overlooked if the posterior aspect of the elbow is not specifically examined. [13] A single avulsed bone fleck present on the lateral radiograph of the elbow may be the only clue for correct diagnosis.

Zacharia and Roy described a clinicoradiologic classification of traumatic triceps tendon avulsion that included the following four types [14] :

  • Type I - Palpable soft-tissue defect without a bony mass
  • Type II - Palpable soft-tissue defect with a wafer-thin/comminuted bony fragment on radiography
  • Type III - Palpable soft-tissue defect with a bony mass and a large bony fragment on radiography without extension to the articular surface
  • Type IV - Olecranon fracture with < 25% of the articular surface

Ultrasonography (US) or magnetic resonance imaging (MRI) may be needed to clarify an uncertain diagnosis or to confirm clinical suspicion. [15, 16]