What is the best course of treatment for a patient with chronic tricep (triceps) tendonitis that has persisted for 6 months, and should an MRI (Magnetic Resonance Imaging) be considered?

Triceps Tendonitis at 6 Months: MRI Recommendation

Yes, you should get an MRI after 6 months of persistent triceps tendonitis, as this represents recalcitrant pain despite adequate conservative management and warrants advanced imaging to guide further treatment decisions. 1

Why MRI is Indicated Now

Guideline-based imaging criteria for chronic tendinopathy clearly support MRI at this stage:

• Advanced imaging should be obtained when pain persists despite adequate conservative management, which your 6-month duration clearly represents 1
• MRI is useful for showing degenerative thickening of tendons, fibrovascular proliferation, mucoid degeneration, and partial tendon tears in elbow tendinopathy 1
• MRI serves as the diagnostic gold standard for triceps tendon pathology, with superior ability to differentiate partial from complete tears 2

What MRI Will Reveal

MRI provides critical information that changes management:

• Distinguishes between tendinosis (chronic degeneration) versus partial or complete tears, which have different treatment algorithms 3, 4
• Identifies the extent of tendon involvement and any musculotendinous retraction that would necessitate surgical intervention 4
• Detects concomitant injuries such as olecranon abnormalities or other soft tissue pathology 2

Treatment Decision Points Based on Imaging

Your management pathway depends on MRI findings:

• If partial tear with intact strength: Continue conservative management but consider surgery if no improvement after 6 months total (which you've now reached) 3
• If partial tear with strength deficits: Surgery should be considered 3
• If complete tear: Surgical repair is strongly recommended 4
• If pure tendinosis without tear: Intensify conservative measures including eccentric exercises, which have proven beneficial in other tendinopathies 1

Critical Timing Considerations

The 6-month mark is a recognized decision point:

• Chronic elbow tendinitis typically requires 3-6 months to resolve with optimal management 5
• Surgery is indicated if conservative management fails for 6 months 3
• You are now at the threshold where surgical evaluation becomes appropriate if imaging reveals significant pathology 3

Common Pitfall to Avoid

Do not continue indefinitely with conservative management without imaging:

• Triceps tendon injuries are clinically underdiagnosed, with tears suspected in only 43% of patients prior to MRI 6
• The prevalence of triceps tendon tears is 3.8% on MRI studies, higher than commonly reported 6
• Delayed diagnosis can lead to musculotendinous retraction requiring more complex surgical reconstruction 4

Alternative Imaging Consideration

Ultrasound is an option but has limitations:

• Ultrasound can demonstrate tendon thickening and heterogeneous echogenicity in elbow tendinopathy 1
• However, MRI remains superior for surgical planning and detecting partial tears 1
• If cost or access is a barrier, ultrasound by an experienced operator can be considered as an initial step 1