Case Report:Triceps Tendon Avulsion: A Rare Injury

Abstract

BackgroundTriceps tendon avulsion is one of the rare tendinous injuries. Such injuries can easily be missed, and should be kept as a differential diagnosis in all patients who present with pain and swelling at the back of the elbow after a traumatic event.Case DetailsWe present a case of triceps tendon avulsion which was missed in the initial workup by a local practitioner. Careful physical examination and evaluation of the X-rays clinched the diagnosis. The patient was treated surgically by transosseous suture technique using the Krakow method. The end result was a good range of movement and a power equal to the uninjured side. A high index of suspicion, physical examination seeking a palpable gap, and search for a ‘flake’ fracture on lateral radiographs will help make the diagnosis of triceps avulsion. Early recognition of these injuries and prompt intervention are the cornerstones of a successful outcome. A second examination after a few days, when the swelling has reduced, should be the standard in doubtful cases or during any unclear joint injury. We recommend a primary repair through a transosseous suture technique using Krakow method for optimal results.

Triceps Tendon Avulsion in an Army Recruit: A Case Report

“…Literature supports that, if a patient can perform active elbow extension against gravity (power of triceps >3/5), the injury is partial and can be treated non-operatively with splint protection for about 4 Weeks [5].…”

“…Triceps tendon avulsion or rupture is a rare injury, with only handful cases in literature [1][2][3][4][5][6][7][8] and is the least common of all tendon injuries [1,4]. The application of a sudden eccentric load to contracted muscle, usually occurring after a fall on the outstretched hand, is the most common mechanism leading to avulsion of a small fragment from bony insertion or rupture of the muscle belly.…”

“…The application of a sudden eccentric load to contracted muscle, usually occurring after a fall on the outstretched hand, is the most common mechanism leading to avulsion of a small fragment from bony insertion or rupture of the muscle belly. However, ruptures have been reported after direct trauma to the posterior aspect of the arm [4][5][6] but in cases with spontaneous tendon rupture or rupture due to minimal or moderate force, predisposing factors, such as hyperparathyroidism secondary to chronic renal failure, hypocalcemic tetany, rheumatoid arthritis, osteogenesis imperfecta, anabolic steroid use, local steroid injection, and insulin-dependent diabetes should be ruled out [4].…”

“…So a second examination after a few days, when the swelling has reduced, should be the standard in doubtful cases or in any unclear joint injury. Although triceps tendon rupture is associated with small flakes of avulsed bone which may visible on radiographs but if the radiographs are of poor quality they may be missed.MRI and ultrasound are useful modalities in unclear and doubtful cases [4,5].…”

“…The triceps tendon was reattached using the Krakow method, constituting a 4-strand of No. 5 Ethibond suture [5]. The triceps tendon stump was positioned at the original insertion into the olecranon to restore the excursion length of the tendon by passing the sutures through bone tunnels made into the olecranon.…”