Triceps tendonitis

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Introduction[edit | edit source]

Triceps tendonitis is the rarest tendonitis of the elbow.[1] Is a condition in which there is an inflammation in the triceps tendon which causes pain in the back of the elbow. The muscle on the back of the arm is called triceps brachii. The triceps passes behind the shoulder joint and ends at the back of the forearm after crossing the back surface of the elbow. During its contraction, tension passes through its tendon. When this tendency is an increase or repeated many times then his tendon is injured. His injury is followed by degeneration and inflammation. This happens traumatically after a great deal of strain has been exerted on the tendon or by gradual minor injuries due to overuse.[2]

Clinically relevant anatomy[edit | edit source]

The triceps brachii muscle derives its name from a tripartite origin consisting of medial, lateral, and long heads. The origin of the medial head is at the dorsal humerus, inferior to the radial groove, and connecting to the intermuscular septum. The lateral head originated at the dorsal humerus, superior to the radial groove. The origin of the long head is the infra-glenoid tubercle of the scapula. The three heads combine to form a single tendon which is inserted on the olecranon of the ulna. The function of the triceps brachii is extension of the forearm at the elbow joint. Additionally, its long head contributes to the extension and adduction of the arm at the shoulder joint. Triceps also plays a role in creating anatomical spaces which are traversed by neurovascular structures. The innervation of the triceps is provided by the radial nerve. The muscle is supplied by the deep brachial artery.[3]

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Epidemiology/Etiology[edit | edit source]

Triceps tendonitis is the least common injury in the elbow area and is mainly due to overuse syndrome. Tendonitis can occur patients of all ages[5] mostly affects the men population[6] and even more so in professional weight lifters[7], throwing athletes and soccer players[8] due to the constant of the elbow extension mechanism. It is also observed in sports that require quick triceps contraction such as off-road mountain biking, motorcycle riding and jumping[9]. People with reduced strength or flexibility and simply lifting heavy objects increase the risk at tendonitis of the triceps. if not treated properly, the recovery process is lengthened.

Pathophysiology[edit | edit source]

Tendonitits of the triceps occurs most often in the osteo-tendon joint of the tendon in the olecranon but also in the tendon itself or in the myotendinous joint. As systematic risk factors that weaken the tendon have been reported as metabolic syndromes, endocrine disorders such as diabetes and hypoparathyroidism. On the other hand, local factors that lead to weakening or injury of the tendon include the injection of corticosteroids, anabolic steroids and overtraining, leading to tendon disease or partial or complete rupture of the tendon.[10][11]

Clinical representation[edit | edit source]

The main symptoms of triceps tendonitis are sensitivity and pain lengthwise of the tendon or sensitivity and localized pain in the insertion into the olecranon. The pain exacerbates with forced extension against resistance.[12] Patients describe pain and/or weakness in activities which require the elbow extension. It is also possible that there's swelling around the elbow. Distal triceps tendinitis is characterized by tenderness at the insertion of the triceps muscle, and pain is exacerbated with active or resisted elbow extension.

Triceps Tendinitis Associated Injuries / Differential Diagnosis[edit | edit source]

Diagnostic procedures[edit | edit source]

Most of the times, diagnosis is delayed due to misdiagnosis. [1]A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose triceps tendonitis. Occasionally, further investigations such as an ultrasound, X-ray, CT scan or MRI scan may be required to assist with diagnosis and assess the severity of the condition.[13][14]

Outcome measures[edit | edit source]

The dash questionnaire of disabilities of the arm, shoulder and hand.

Medical Management[edit | edit source]

In some cases, triceps tendonitis can be managed conservatively with activity modification, NSAIDs and occasionally resting splints.[15]

Physiotherapy management[edit | edit source]

Physiotherapy management includes a period of immolization followed by ROM and then strengthening exercises.Initial splint immobilization with the elbow in 30o of flexion is continued for around 4 weeks. Following immobilization, gradual progression of elbow motion is allowed as tolerated, with the aim to achieve full ROM within 12 weeks. The final stage is to introduce exercises to increase extension strength. Full extension strength can be achieved between 6 and 9 months.[16]

Related articles[edit | edit source]

References[edit | edit source]

  1. ↑ 1.0 1.1 Lappen S, Geyer S, Scheiderer B, Macken C, Mazzocca AD, Imhoff AB, Siebenlist S. Distal triceps tendinopathies. Obere Extremität 2020:1-5.
  2. ↑ Jafarnia K, Gabel GT, Morrey BF. Triceps tendinitis. Operative Techniques in Sports Medicine. 2001 Oct 1;9(4):217-21.
  3. ↑ Tiwana MS, Sinkler MA, Bordoni B. Anatomy, Shoulder and Upper Limb, Triceps Muscle. StatPearls [Internet]. 2020 May 30.
  4. ↑ Triceps Brachii Muscle - Origin, Insertion & Innervation - Human Anatomy | Kenhub. Available from: https://www.youtube.com/watch?v=R-TxrDzYSdM&feature=emb_logo [ Last accessed 30/9/2020]
  5. ↑ Celli A, Arash A, Adams RA, Morrey BF. Triceps insufficiency following total elbow arthroplasty. JBJS. 2005 Sep 1;87(9):1957-64.
  6. ↑ Dunn JC, Kusnezov N, Fares A, Rubin S, Orr J, Friedman D, Kilcoyne K. Triceps tendon ruptures: a systematic review. Hand. 2017 Sep;12(5):431-8.
  7. ↑ Sollender JL, Rayan GM, Barden GA. Triceps tendon rupture in weight lifters. Journal of Shoulder and Elbow Surgery. 1998 Mar 1;7(2):151-3.
  8. ↑ Sierra RJ, Weiss NG, Shrader MW, Steinmann SP. Acute triceps ruptures: case report and retrospective chart review. Journal of shoulder and elbow surgery. 2006 Jan 1;15(1):130-4.
  9. ↑ Jafarnia K, Gabel GT, Morrey BF. Triceps tendinitis. Operative Techniques in Sports Medicine. 2001 Oct 1;9(4):217-21.
  10. ↑ Taylor S, Hannafin J. Evaluation and Management of Elbow Tendinopathy. Sports Health: A Multidisciplinary Approach. 2012;4(5):384-393.
  11. ↑ Dunn JC, Kusnezov N, Fares A, Rubin S, Orr J, Friedman D, Kilcoyne K. Triceps tendon ruptures: a systematic review. Hand. 2017 Sep;12(5):431-8.
  12. ↑ Laratta J, Caldwell JM, Lombardi J, Levine W, Ahmad C. Evaluation of common elbow pathologies: a focus on physical examination. The Physician and Sportsmedicine. 2017 Apr 3;45(2):184-90.
  13. ↑ Tom JA, Kumar NS, Cerynik DL, Mashru R, Parrella MS. Diagnosis and treatment of triceps tendon injuries: a review of the literature. Clinical Journal of Sport Medicine. 2014 May 1;24(3):197-204.
  14. ↑ Taylor SA, Hannafin JA. Evaluation and management of elbow tendinopathy. Sports Health. 2012 Sep;4(5):384-93.
  15. ↑ Donaldson O, Vannet N, Gosens T, Kulkarni R. Tendinopathies around the elbow part 2: medial elbow, distal biceps and triceps tendinopathies. Shoulder & Elbow. 2014 Jan;6(1):47-56.
  16. ↑ Demirhan M, Ersen A. Distal triceps ruptures. EFORT Open Reviews. 2016;1(6):255-259.
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