Diagnosis and Treatment of Triceps and Scapula Issues
For triceps and scapula issues, CT is the best imaging modality for diagnosis, particularly for scapula fractures, while MRI is superior for evaluating soft tissue injuries including triceps tears. 1
Diagnostic Approach
Initial Evaluation
- Standard radiographs should be the first imaging study for both triceps and scapula issues, including anteroposterior (AP) views in internal and external rotation and an axillary or scapula-Y view 1
- Radiographs may reveal fractures, dislocations, or degenerative changes but often miss soft tissue injuries 1
Advanced Imaging for Scapula Issues
- CT is the preferred imaging modality for scapula fractures due to the complex osteology and overlying ribs that can obscure findings on plain radiographs 1
- Three-dimensional CT reformatting provides superior visualization of scapula fracture displacement and angulation 1
- MRI is recommended for suspected soft tissue injuries around the scapula 1
- Ultrasound has limited utility for scapula issues 1
Advanced Imaging for Triceps Issues
- MRI is the gold standard for diagnosing triceps tears, with superior sensitivity for detecting both partial and complete tears 1
- Ultrasound can be used to evaluate triceps tendon integrity but has lower sensitivity and specificity compared to MRI 1
- MRI can differentiate between direct and indirect triceps injuries, which have different injury patterns and associated findings 1
Treatment Options
Conservative Management for Triceps Tendinopathy
- Rest to prevent ongoing damage while maintaining some activity that doesn't worsen pain 1
- Ice therapy for 10-minute periods through a wet towel to reduce pain and swelling 1
- NSAIDs (oral or topical) for pain relief 1
- Eccentric strengthening exercises once acute pain subsides 1
Surgical Management for Triceps Tears
- Complete triceps tears typically require surgical repair, especially in active individuals 1
- Partial tears may be managed conservatively initially with activity modification and physical therapy 1
Management of Scapula Fractures
- Isolated scapula body fractures generally heal well without surgical fixation 1
- Surgical intervention may be indicated for:
Management of Snapping Scapula Syndrome
- Initial conservative treatment includes:
- Activity modification
- Physical therapy
- Anti-inflammatory medications
- Corticosteroid injections 2
- When conservative management fails, surgical options include:
- Arthroscopic scapulothoracic bursectomy
- Partial scapulectomy of the superomedial scapula 2
Management of Sprengel's Deformity (Congenital High Scapula)
- Surgical correction may include:
- Partial scapular resection
- Removal of any omovertebral communication
- Release of the long head of triceps from the scapula 3
- Early postoperative active-assisted motion exercises are encouraged 3
Special Considerations
- For scapulothoracic disorders, consider the relationship between scapular position and triceps function, as the long head of the triceps originates from the infraglenoid tubercle of the scapula 3
- In cases of combined pathology, address both components to achieve optimal outcomes 1
- For pediatric patients with scapular issues, referral to a pediatric orthopedic specialist is recommended, especially for congenital or developmental conditions 1
Common Pitfalls
- Failing to obtain adequate imaging (particularly axillary or scapula-Y views) can lead to missed diagnoses of shoulder dislocations 1
- Overlooking associated injuries, particularly in traumatic cases where multiple structures may be affected 1
- Attributing symptoms solely to obvious bony pathology while missing underlying soft tissue injuries 1
- Delaying treatment of complete triceps tears can lead to retraction and more difficult repair 1