What is the workup for a torn triceps (triceps tendon rupture)?

Workup for Triceps Tendon Rupture

MRI without contrast is the gold standard imaging modality for diagnosing triceps tendon rupture, providing superior assessment of tear type and associated injuries, and should be performed when surgical intervention is being considered. 1, 2

Clinical Examination

• Look for:

  • Visible deformity at the posterior elbow
  • Ecchymosis around the elbow
  • Palpable defect at the triceps insertion
  • Weakness or inability to extend the elbow against resistance
  • Pain with active extension

• Mechanism of injury is important to document:

  • Fall on an outstretched hand (indirect injury) - typically affects lateral and long heads with intact medial head
  • Direct blow to the triceps (direct injury) - more likely to cause full-thickness rupture 1

Imaging Algorithm

1. Plain Radiographs (X-rays):

   • First-line imaging for all acute elbow pain
   • Can identify avulsion fractures at the olecranon (fleck sign)
   • Helps exclude other bony pathology 2

2. Ultrasound:

   • Can identify complete and isolated partial tears of the triceps tendon
   • Advantages: non-invasive, readily available, cost-effective
   • Limitations: operator-dependent, less accurate for partial tears 1

3. MRI without contrast:

   • Gold standard for definitive diagnosis
   • Superior for:
     • Accurately identifying tear type (complete vs. partial)
     • Assessing extent of tendon retraction
     • Visualizing associated injuries
   • Essential when surgical intervention is being considered 1, 2

Important Clinical Considerations

• Triceps tendon ruptures are rare (less than 1% of all tendon injuries) and frequently missed on initial presentation 3, 4

• Complete tears require surgical repair for optimal outcomes, while partial tears may be managed conservatively 3, 5

• Delayed diagnosis can lead to:

  • Tendon retraction
  • More complex surgical repair
  • Poorer functional outcomes 4, 6

• Associated injuries to assess for:

  • Ligamentous injuries (more common with indirect mechanism) 1
  • Elbow joint instability
  • Other tendon pathologies

Pitfalls to Avoid

• Misdiagnosis is common due to the rarity of the condition - maintain high index of suspicion with appropriate mechanism and symptoms 4

• MRI may overestimate triceps tear severity compared to surgical assessment - clinical correlation is essential 1

• Late presentation (missed diagnosis) requires more complex surgical management and may have suboptimal outcomes 4, 6

• Failure to identify and address associated injuries can lead to persistent symptoms and functional limitations