What is the treatment for a triceps tendon tear?

Treatment for Triceps Tendon Tear

Complete triceps tendon tears require surgical repair to restore active elbow extension, while partial tears with intact strength can be managed conservatively with rest, immobilization, NSAIDs, and physical therapy for up to 6 months before considering surgery. 1, 2, 3

Initial Assessment and Decision-Making

The critical distinction is between partial and complete tears, determined by motor examination:

• Complete tears present with loss of active elbow extension strength and require surgical intervention 2, 3
• Partial tears with preserved extension strength can initially be managed conservatively 1, 3
• Physical examination should specifically assess for extension strength deficits, palpable tendon defects, and well-localized tenderness at the olecranon insertion 4, 5
• MRI is the diagnostic gold standard for confirming the diagnosis and defining the extent of injury 5, 6

Conservative Management (For Partial Tears Only)

Conservative treatment is appropriate only when extension strength remains intact 1:

• Relative rest by reducing activities that provoke pain while maintaining some movement to prevent muscle atrophy and deconditioning 4, 1
• Immobilization in the acute phase to prevent ongoing damage 1
• Ice therapy for short-term pain relief and reduction of swelling 4
• NSAIDs (oral or topical) for acute pain relief, with topical formulations preferred to eliminate gastrointestinal hemorrhage risk 4
• Physical therapy with eccentric strengthening exercises once acute pain subsides, as these stimulate collagen production and guide proper alignment of newly formed collagen fibers 4, 1
• Duration: Trial conservative management for up to 6 months 1

Surgical Indications

Surgery should be pursued in the following scenarios:

• All complete triceps tendon tears to restore active elbow extension 2, 3
• Partial tears with strength deficits on examination 1
• Failed conservative management after 6 months for partial tears 1
• Substantial musculotendinous retraction even in partial tears 3
• Consider patient age, functional demands, dominant extremity involvement, and extent of rupture when making surgical decisions 5

Surgical Approach

• Acute complete tears: Direct repair to the olecranon insertion is the standard approach 2
• Chronic or near-complete tears: May require reconstruction using tendon autograft (such as ipsilateral palmaris longus) or Achilles tendon allograft when primary repair is not feasible 2, 6
• Surgical techniques typically involve reattachment through bone tunnels in the olecranon 2, 6
• Rerupture risk: The most significant surgical complication occurs in approximately 4.62% of cases 1

Critical Pitfalls to Avoid

• Do not attempt conservative management for complete tears – these universally require surgical repair to restore function 2, 3
• Do not delay diagnosis – chronic tears are more difficult to manage and may require complex reconstruction rather than simple repair 6
• Avoid corticosteroid injections – these may predispose to tendon rupture by reducing tensile strength 4
• Do not immobilize completely for extended periods – this leads to muscle atrophy and joint stiffness 4

Postoperative Rehabilitation

• Early postoperative elbow range of motion is beneficial 6
• Active elbow extension typically allowed at 6 weeks post-reconstruction 6
• Progressive strengthening follows initial healing phase 1