Triceps brachii

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Description

The triceps brachii is a large, thick muscle on the dorsal part of the upper arm. It often appears as the shape of a horseshoe on the posterior aspect of the arm. The main function of the triceps is the extension of the elbow joint.

The Triceps brachii gets its name with tri referring to "three" muscle heads or points of origin (with Brachii referring to the arm). These include the: Medial head; Lateral head; Long head

Image 1: Triceps brachii muscle: Long head red; Lateral head yellow; Medial head green

Triceps brachii - Muscles

Long head

• 
  Origin: infraglenoid tubercle of the scapula
• Insertion: Posterior surface of the olecranon process of the ulna, capsule of the elbow joint and antebrachial fascia.
• Action: Because it attaches to the scapula, the long head not only extends the elbow but will also have a small action on the glenohumeral joint. With the arm adducted, the triceps muscle acts to hold the head of the humerus in the glenoid cavity. This action helps prevent any displacement of the humerus. The long head also assists with the extension and adduction of the arm at the shoulder joint. The lateral head is also active during extension of the forearm at the elbow joint when the forearm is supinated or pronated.
• Innervation: radial nerve

Image 2: Long head of triceps brachii muscle (highlighted in green) - posterior view

Lateral Head

• Origin: posterior aspect of the humerus, superior to the radial groove
• Insertion: Posterior surface of the olecranon process of the ulna, capsule of the elbow joint and antebrachial fascia.
• Action: Strongest head of the three. It is active during extension of the forearm at the elbow joint when the forearm is supinated or pronated.
• Innervation: radial nerve

Medial head

• Origin: posterior aspect of humerus, inferior to the radial groove
• Insertion: Posterior surface of the olecranon process of the ulna, capsule of the elbow joint and antebrachial fascia.
• Action: As the medial head does not attach to the scapula and therefore has no action on the glenohumeral joint, whether with stabilization or movement. However, the medial head is active during extension of the forearm at the elbow joint when the forearm is supinated or pronated.  
• Innervation: radial nerve

Note: All the three heads of triceps brachii are innervated by the four branches of the radial nerve (C7, C8). However, according to the cadaveric study it is found that the medial head of triceps brachii is innervated by the ulnar nerve.. Some research reveals that the long head of triceps is actually innervated by the axillary nerve.

The muscle is supplied with oxygen and nutrients from the branches of the deep brachial artery.

Muscle Fibre Types

Muscle histology and average innervation ratios estimated from absolute mononeurons (MN) counts shows that the lateral head is used for movements requiring occasional high-intensity force, while the medial head enables more precise, low-force movements.

1. medial head was predominantly formed by small type I muscle fibers and motor units (69 fibers/MN).
2. the lateral head comprised a great quantity of large type IIb fibers and motor units (179 fibers/MN)
3. the long head consisted of a more balanced mixture of fiber types and motor units (99 fibers/MN).

Physiotherapy

The triceps reflex, elicited by sharply striking the triceps tendon, is often used to test the function of the nerves of the arm. This reflex tests spinal nerves C6 and C7, predominately C7. The reflex is tested by abducting the patient's shoulder and elbow to 90 degrees. Then the triceps tendon is tapped using a reflex hammer just proximal to the olecranon.

Axillary nerve damage can have an impact on the long head of the triceps brachii (LTB). Therefore, people with axillary nerve damage should undergo an assessment for the function of the LTB. If they demonstrate lost function, this shows a poor prognosis, and early repair at three months is recommended.

The triceps muscle can undergo reinnervation through a distal nerve transfer. Commonly used nerves for reinnervation include the flexor carpi ulnaris fascicle of the ulnar nerve and the posterior branch of the axillary nerve. Both of these nerves have been shown to recover the function of the triceps muscle.

Ruptures of the triceps muscle are rare and typically only occur in anabolic steroid users. Distal triceps ruptures are also relatively uncommon. The injury typically occurs due to either a fall on an outstretched hand or a direct blow to the triceps tendon. The patient presents after a painful popping sensation with pain and swelling over the posterior elbow with the inability to extend the elbow against resistance.

Strengthening exercises: The triceps brachii can undergo training in a variety of different ways. It can be worked out in isolation or with compound elbow extension movements. It can also be contracted statically to keep the arm straight against resistance.

Examples

1. Isolation movements: lying triceps extensions, behind-the-back arm extensions, cable push-downs, and standing triceps "kickbacks."
2. The compound exercises: any pressing movements like push-ups, bench press, close grip bench press, tricep dips, and military presses. The closer the grip on these exercises, the more they isolate the triceps. The wider the grip, the more they work the outer chest.
3. Static contraction movements include pullovers, straight-arm pull-downs, and bent-over lateral raises, which are also used to build the deltoids and latissimus dorsi.

Watch these short videos below for more ideas

Strengthening

Stretching

Palpation

To palpate the three heads of the triceps have the patient in high sitting position and stand behind the patient

1. Palpation of medial head- Firstly, use a landmark to palpate the muscle. In this case, the landmark would be medial epicondyle of the humerus. The examiner will place his/her three fingers just above the medial epicondyle and instruct the patient to extend the elbow pushing downward force on the couch as if to lift himself or herself up. Finally palpate the medial head.
2. Palpation of long head- Palpate from medial condyle of the humerus up to the axilla posteriorly would be the area for long head of triceps. Just beneath the axilla posteriorly, the examiner will place his/her three fingers & instruct the patient to extend the elbow pushing downward. Finally, palpate the long head of the triceps.
3. Palpation of lateral head- In order to palpate for the lateral head, place three fingers to the postero-lateral side in the middle of the shaft of the humerus & instruct the patient to extend the elbow.
4. Anconeus- To palpate the anconeus, the landmark would be lateral condyle of the humerus to the proximal ulna & instruct the patient to extend the elbow.

Resources

The 3 minute video is on the anatomy of Triceps