Triceps Tears: Diagnosis and Management Options

“Torn triceps can be a serious injury for athletes and sports enthusiasts. Can knowing their symptoms, causes, risk factors and potential complications help healthcare providers develop an effective treatment plan?”

Torn Triceps Injury

The triceps is the muscle on the back of the upper arm that allows the elbow to straighten. Fortunately, triceps tears are uncommon, but they can be serious. The injury affects men more often than women and usually occurs from trauma, sports, and/or exercise activities. Depending on the extent and severity of the injury, a torn triceps injury can require splinting, physical therapy, and possibly surgery to regain movement and strength. Recovery after a triceps tear typically lasts around six months. (The Ohio State University Wexner Medical Center. 2021)

Anatomy

The triceps brachii muscle, or triceps, runs along the back of the upper arm. It is named tri- because it has three heads – the long, medial, and lateral head. (Sendic G. 2023) The triceps originates at the shoulder and attaches to the shoulder blade/scapula and upper arm bone/humerus. At the bottom, it attaches to the point of the elbow. This is the bone on the pinky side of the forearm, known as the ulna. The triceps cause movement at the shoulder and the elbow joint. At the shoulder, it performs extension or backward movement of the arm and adduction or moving the arm toward the body. The main function of this muscle is at the elbow, where it performs extension or straightening of the elbow. The triceps work the opposite of the biceps muscle on the front of the upper arm, which conducts flexion or bending of the elbow.

Triceps Tear

Tears can occur anywhere along the length of a muscle or tendon, which is the structure that attaches the muscle to the bones. Triceps tears commonly occur in the tendon connecting the triceps to the back of the elbow. Muscle and tendon tears are graded from 1 to 3 based on severity. (Alberto Grassi et al., 2016)

Grade 1 Mild

• These small tears cause pain that worsens with movement.
• There is some swelling, bruising, and minimal loss of function.

Grade 2 Moderate

• These tears are larger and have moderate swelling and bruising.
• The fibers are partially torn and stretched.
• Up to 50% loss of function.

Grade 3 Severe

• This is the worst type of tear, where the muscle or tendon is completely torn.
• These injuries cause severe pain and disability.

Symptoms

Triceps tears cause immediate pain in the back of the elbow and upper arm that worsens when trying to move the elbow. Individuals might also feel and/or hear a popping or tearing sensation. There will be swelling, and the skin will likely be red and/or bruised. With a partial tear, the arm will feel weak. If there is a complete tear, there will be significant weakness when straightening the elbow. Individuals may also notice a lump on the back of their arm where the muscles have contracted and knotted together.

Causes

Triceps tears usually occur during trauma, when the muscle is contracted and an external force pushes the elbow into a bent position. (Kyle Casadei et al., 2020) One of the most common causes is by falling on an outstretched arm. Triceps tears also occur during sports activities like:

• Throwing a baseball
• Blocking in a football game
• Gymnastics
• Boxing
• When a player falls and lands on their arm.
• Tears can also happen when using heavy weights during triceps-targeted exercises, such as the bench press.
• Tears can also occur from direct trauma to the muscle, like a motor vehicle accident, but are less common.

Long-Term

Triceps tears can develop over time as a result of tendonitis. This condition usually occurs from repetitive use of the triceps muscle during activities like manual labor or exercise. Triceps tendonitis is sometimes referred to as weightlifter’s elbow. (Orthopedic & Spine Center. N.D.) The strain on tendons causes tiny tears that the body typically heals. However, if more strain is placed on the tendon than it can keep up with, the tiny tears can begin to grow.

Risk Factors

Risk factors can increase the risk of a triceps tear. Underlying medical conditions can weaken tendons, increasing the risk of injury, and can include: (Tony Mangano et al., 2015)

• Diabetes
• Rheumatoid arthritis
• Hyperparathyroidism
• Lupus
• Xanthoma – fatty deposits of cholesterol under the skin.
• Hemangioendothelioma – cancerous or noncancerous tumors caused by abnormal growth of blood vessel cells.
• Chronic kidney failure
• Chronic tendonitis or bursitis in the elbow.
• Individuals who have had cortisone shots in the tendon.
• Individuals using anabolic steroids.

Triceps tears tend to occur more commonly in males between 30 and 50. (Ortho Bullets. 2022) This comes from participating in activities like football, weightlifting, bodybuilding, and manual labor, which also increases the risk of injury.

Treatment

Treatment depends on which part of the triceps is affected and the extent of the damage. It may only need resting for a few weeks, physical therapy, or require surgery.

Nonsurgical

Partial tears in the triceps that involve less than 50% of the tendon can often be treated without surgery. (Mehmet Demirhan, Ali Ersen 2016) Initial treatment includes:

• Splinting the elbow with a slight bend for four to six weeks allows the injured tissue to heal. (Ortho Bullets. 2022)
• During this time, ice can be applied to the area for 15 to 20 minutes several times daily to help decrease pain and swelling.
• Non-steroidal anti-inflammatory medications/NSAIDs – Aleve, Advil, and Bayer can help reduce inflammation.
• Other over-the-counter medications like Tylenol can help decrease the pain.
• Once the splint is removed, physical therapy will help restore movement and strength in the elbow.
• Full movement is expected to return within 12 weeks, but full strength will not return until six to nine months after the injury. (Mehmet Demirhan, Ali Ersen 2016)

Surgery

Triceps tendon tears that involve more than 50% of the tendon require surgery. In some cases, however, surgery may still be recommended for tears smaller than 50% if the individual has a physically demanding job or plans to resume playing sports at a high level. Tears in the muscle belly or area where the muscle and tendon join are typically sewn back together. If the tendon is no longer attached to the bone, it is screwed back on. Recovery and physical therapy after surgery depend on the specific surgeon’s protocols. In general, individuals will spend a couple of weeks in a brace. Around four weeks after surgery, individuals will be able to start moving the elbow again. However, they won’t be able to start doing heavy lifting for four to six months. (Ortho Bullets. 2022) (Mehmet Demirhan, Ali Ersen 2016)

Complications

Complications can occur after triceps repair, whether there was surgery or not. For example, individuals may have problems regaining full elbow extension or straightening. They are also at a higher risk of re-rupture if they try to use the arm before it’s fully healed. (Mehmet Demirhan, Ali Ersen 2016)

Chiropractic Care for Healing After Trauma

References

The Ohio State University Wexner Medical Center. (2021). Distal triceps repair: clinical care guideline. (Medicine, Issue. medicine.osu.edu/-/media/files/medicine/departments/sports-medicine/medical-professionals/shoulder-and-elbow/distaltricepsrepair.pdf?

Sendic G. Kenhub. (2023). Triceps brachii muscle Kenhub. www.kenhub.com/en/library/anatomy/triceps-brachii-muscle

Grassi, A., Quaglia, A., Canata, G. L., & Zaffagnini, S. (2016). An update on the grading of muscle injuries: a narrative review from clinical to comprehensive systems. Joints, 4(1), 39–46. doi.org/10.11138/jts/2016.4.1.039

Casadei, K., Kiel, J., & Freidl, M. (2020). Triceps Tendon Injuries. Current sports medicine reports, 19(9), 367–372. doi.org/10.1249/JSR.0000000000000749

Orthopedic & Spine Center. (N.D.). Triceps tendonitis or weightlifter’s elbow. Resource Center. www.osc-ortho.com/resources/elbow-pain/triceps-tendonitis-or-weightlifters-elbow/

Mangano, T., Cerruti, P., Repetto, I., Trentini, R., Giovale, M., & Franchin, F. (2015). Chronic Tendonopathy as a Unique Cause of Non Traumatic Triceps Tendon Rupture in a (Risk Factors Free) Bodybuilder: A Case Report. Journal of orthopaedic case reports, 5(1), 58–61. doi.org/10.13107/jocr.2250-0685.257

Ortho Bullets. (2022). Triceps rupture www.orthobullets.com/shoulder-and-elbow/3071/triceps-rupture

Demirhan, M., & Ersen, A. (2017). Distal triceps ruptures. EFORT open reviews, 1(6), 255–259. doi.org/10.1302/2058-5241.1.000038