Management of Partial Triceps Tendon Tears
Initial Treatment Recommendation
Partial triceps tendon tears with intact elbow extension strength should be managed conservatively with rest, immobilization, NSAIDs, and physical therapy, reserving surgery only for cases that fail 6 months of conservative treatment or demonstrate strength deficits on examination. 1
Conservative Management Protocol
Initial Treatment Components
- Immobilization in a posterior splint or brace with the elbow in extension to minimize tension on the healing tendon 1
- Rest from aggravating activities, particularly eccentric loading and resistance exercises 1, 2
- NSAIDs for pain control and inflammation management 1
- Ice application to reduce swelling and pain 1
Key Clinical Criterion: Motor Examination
- The critical determinant for conservative versus surgical management is intact elbow extension strength on physical examination 1
- Patients with strength deficits at initial presentation should be considered for early surgical intervention rather than prolonged conservative trial 1
- Partial tears can heal without functional deficit when motor strength is preserved 3
When to Consider Surgery
Indications for Surgical Intervention
- Failure of conservative management after 6 months of appropriate nonoperative treatment 1
- Strength deficits on examination at any point during treatment 1
- Substantial musculotendinous retraction identified on imaging 2
- Progression to complete tear during conservative management (occurred in 1 of 10 partial tears in professional football players) 3
Evidence Supporting Conservative Approach
- In a study of NFL players, 6 of 10 partial tears healed without surgery and players returned to professional football 3
- Only 3 players with partial tears required delayed surgical repair due to residual pain and weakness after the season 3
- Conservative management success depends on the absence of significant strength deficits 1, 2
Common Pitfalls to Avoid
Diagnostic Errors
- Missing the diagnosis entirely - triceps tendon ruptures are often initially missed, requiring thorough clinical examination 4
- Failing to assess extension strength properly - this is the key differentiator between surgical and nonsurgical candidates 1
- Not obtaining advanced imaging when clinical examination is equivocal - ultrasound or MRI can confirm partial versus complete tears 2, 4
Treatment Errors
- Premature return to activity before adequate healing, particularly in athletes and weightlifters 3, 2
- Ignoring prodromal symptoms - 7 of 21 players in one study had warning symptoms before complete injury 3
- Continuing corticosteroid injections - 5 players who sustained tears had received prior cortisone injections, suggesting this may be a risk factor 3
Risk Factors Requiring Heightened Vigilance
- Middle-aged men, particularly those involved in weightlifting or football 2
- Anabolic steroid abuse in weightlifters (most common predisposing factor in some practices) 4
- History of prodromal symptoms or prior corticosteroid injections 3
- Chronic overuse causing degenerative changes at the insertion 4