The triceps muscle is located in the back of your upper arm. It helps in straightening the elbow. The triceps muscle has three tendons, one of which attaches it to the bone in the shoulder and the other attaches at the elbow. A tear in this tendon will make it difficult for you to straighten the elbow against gravity. Once the distal triceps tendon is torn, it cannot regrow back to the bone and heal by itself. Permanent weakness during elbow extension may occur, if the tendon is not repaired surgically.
Triceps tendon tear can be complete or partial. In partial triceps tendon tear, the tendon does not tear completely but is often painful. A Complete tendon tear means it ruptures completely off the ulna bone.
Causes
Distal triceps tendon ruptures most often result from a sudden injury or lifting a heavy object. Additional risk factors, such as advancing age, smoking and use of corticosteroid medications, can also result in increased muscle and tendon weakness, which can lead to the tendon rupture.
Signs and symptoms
The most common symptom is a sudden, severe pain in the back of the elbow. You may feel a “pop” at the elbow when the tendon tears. Other symptoms include swelling, visible bruising, weakness in the back of the elbow, trouble straightening the arm against gravity, and a gap in the back of the elbow, caused by the absence of the tendon. A bulge may also appear in the back arm caused by the recoiled, shortened triceps muscle.
Diagnosis
Distal triceps tendon rupture is usually diagnosed based on symptoms, medical history, and physical examination. During the physical examination, Dr Bala will look for a gap in the tendon by palpating the back part of the elbow. He will also look for movement of the elbow on squeezing the muscle belly. Dr Bala will diagnose a partial tear by asking you to straighten your arm and tighten the triceps muscle, and identify weakness and pain if there is a partial tear. Using an x-ray, Ultrasound or MRI scan, Dr Bala can determine whether the tear is partial or complete.
Non-operative treatment
Tendinitis of the distal triceps tendon without tears or partial tears of the distal triceps can be managed conservatively with rest, pain-killers, and graded physiotherapy to strengthen the tendon. In rare instances Dr Bala may opt to use cells from your own blood that are rich in undifferentiated cells. This preparation is called Platelet Rich Plasma or PRP. This injection may aid healing of minor tears of the distal triceps tendon.
Treatment
During distal triceps repair, Dr Bala makes a small incision over the lower arm, where the triceps muscle attaches to the ulna bone. The torn triceps tendon is brought up through the incision. The ulna bone is then prepared for tendon reattachment and to promote healing. The sutures are passed through the tendon in a particular interlocking manner so as to ensure a strong tendon repair. Dr Bala uses a technique called the suture bridge technique to repair the tendon back to its anatomic footprint (anatomic distal triceps repair) using 2 rows of suture anchors.
If the tear has been long standing an artificial tendon will have to be harvested from the patient’s own body (autograft) or another graft from a compatible donor (allograft) will be used to reconstruct the distal triceps tendon.
Dr Bala will explain in more detail the risks involved with this surgery and what precautions he takes to prevent them from happening. Dr Bala takes special precautions including wearing magnifying loupes while performing this surgery to protect important structures near the elbow to prevent complications. In the event you may have a tattoo on the elbow or forearm Dr Bala is well versed in suturing tattoos back accurately with absorbable sutures. 2 weeks after the surgery, gentle exercises are instituted to regain range of movement and strength to the elbow.
Dr Bala specializes in dealing with complications of distal triceps repair or revisions of failed prior surgery.