Triceps tendon ruptures are rare. We report a case of a partially ruptured triceps tendon in a fit and healthy bodybuilder.
A 44-year old man presented with pain in his right upper arm. He was a bodybuilder and, following a trivial fall onto his flexed right elbow, had subsequently tried to return to his gym activities during which he felt a sudden severe sharp pain in the right posterior upper arm on extending his elbow to resistance. There was no significant past medical history and denied any drug use. Clinically, he had swelling and tenderness proximal to the olecranon process with a boggy swelling over the distal triceps. He had weakness in extending his elbow but was nevertheless able to actively extend it. There were no sensory neurological symptoms or signs.
Plain radiography of his elbow revealed an olecranon traction spur as well as bony avulsion fragments proximal to the distal olecranon.
An ultrasound scan was subsequently performed. This showed partial rupture of the distal triceps tendon, involving the superficial fibres. The superficial fibres were retracted and lay approximately 5cm above the olecranon process. A small haematoma was noted at the site of rupture. The deep fibres were intact. Fragments of bone were also noted at this site, consistent with the plain radiograph findings of an avulsed fragment of the olecranon. Ultrasound of his left elbow, performed for the purpose of comparison, was within normal limits.
The patient was treated conservatively with the elbow held in partial flexion. He gained a full range of motion and is currently undergoing strengthening exercises, which he is expected to fully regain.
Triceps tendon rupture is an uncommon injury. The tear usually occurs at the tendon-osseous junction and is usually accompanied by avulsion fractures of the olecranon process [1]. The majority of ruptures occur following a fall onto the outstretched hand or following direct impact to the arm [1]. However, the injury is also recognised in patients whilst weight lifting [2]. Partial rupture of the tendon is even more rare. Clinical diagnosis is usually obvious but the findings may occasionally be subtle or difficult to assess because of swelling and pain. In this case, the fact that the patient could extend his elbow, although weakly, suggested an incomplete rupture and highlights the need for imaging. MRI provides an excellent overall view of the elbow extensor mechanism and the extent of a tear and muscle retraction [3]. However, ultrasound, together with clinical examination, will often provide the adequate information necessary in order to formulate a management plan, as in this case. Furthermore, the dynamicity of ultrasound gives it obvious advantages over other imaging modalities. Ultrasound should therefore always be considered as the first radiological investigation in suspected triceps ruptures.
Most surgeons will repair complete ruptures surgically. There is, however, no consensus to support either operative or conservative management in partial ruptures, but these are successfully reported in the literature [4]. In our case, conservative management was chosen and proved successful.
Partial rupture of triceps tendon
The patient is a 44-year-old male bodybuilding enthusiast, presenting clinically with reduced elbow extension strength but still able to partially extend the elbow. Based on the X-ray and ultrasound images, the main findings are as follows:
Overall, the imaging findings suggest a partial tear of the triceps tendon, and the avulsed bone fragment along with local hematoma further indicates injury at the tendon insertion.
In summary, local avulsion fractures should be distinguished from tendon injuries, but this case is more suggestive of a partial tear of the triceps tendon with an associated avulsed bone fragment.
Based on the patient’s age, history of bodybuilding, clinical symptoms (weakness in extending the elbow but still able to partially extend), and the imaging evidence, the most likely diagnosis is:
Partial Tear of the Triceps Tendon (with Avulsed Bone Fragment)
No further histological biopsy is currently required. Typically, high-resolution ultrasound or MRI is used to determine the extent of the tear and to decide whether surgical intervention is needed.
For a partial tear of the triceps tendon, conservative management is generally considered first. In cases of complete tear or severe instability, surgical repair is often required.
Rehabilitation/Exercise Prescription (FITT-VP principle):
Throughout the rehabilitation process, closely observe pain, swelling, and strength recovery. Adjust the rehabilitation plan if necessary to ensure safety and effectiveness.
Disclaimer: This report is intended for medical reference only and is not a substitute for a face-to-face diagnosis or professional medical advice. If you have any questions or changes in your condition, please consult a specialist or seek hospital care promptly.
Partial rupture of triceps tendon
