Triceps Tendinitis

By admin On Nov 13, 2023

Ovid: 5-Minute Sports Medicine Consult, The

Triceps Tendinitis

Clint Beaver

David E. Price

Robert L. Jones

Basics

Description

Inflammation of the triceps tendon at or above the insertion onto the olecranon
Classically an overuse injury due to repetitive extension of the elbow or extreme force placed on the tendon
May result from direct trauma

Epidemiology

Uncommon, but higher prevalence observed in certain groups (see “Risk Factors”)
Male predominance of 2:1 (1)[B]
Has been described through a wide range of ages (1)[B]

Risk Factors

Commonly associated with posterior impingement presence of loose bodies, or classic tennis elbow
Activities such as hammering, weightlifting (specifically pushups and dips), throwing (baseball), platform diving, and playing guitar
Use of anabolic steroids may also predispose to injury.

General Prevention

Proper form when lifting weights
Avoid excessive weight or force when utilizing triceps.
Appropriate stretching prior to repetitive use of triceps or weightlifting

Etiology

Inflammation or swelling of the triceps tendon due to excessive force or repetitive use

Commonly Associated Conditions

Olecranon bursitis (2)[C]
Triceps tendon rupture (1,3)[B]

Diagnosis

History

Increasing pain in the posterior elbow over several weeks that worsens over course of the day and associated with occasional morning stiffness
Improvement can be seen with periods of inactivity.

Physical Exam

Pain in the posterior elbow
Pain on full extension/flexion of the elbow
Swelling at or above the tendinous insertion
Weakness with extension of elbow
Tenderness at or above the triceps insertion onto the olecranon
Swelling in the same area
Increased pain with resisted extension of the elbow
Weakness with elbow extension (may be indicative of tendon rupture)

Diagnostic Tests & Interpretation

Imaging

Anterior/posterior and lateral plain films may be helpful; specifically may be useful to evaluate for tendon avulsions (2)[B].
US may be useful in distinguishing between triceps tendonitis and olecranon bursitis if the physical exam is unclear; may also show calcifications within the triceps tendon (3)[B].
MRI is rarely needed.

Differential Diagnosis

Olecranon fracture/stress fracture
Olecranon bursitis
Triceps rupture
Subtendinous bursitis

Treatment

Long-term treatment:
- Prevention is vital in high-risk populations such as weightlifters, carpenters/construction workers, or guitar players; the key to prevention is proper stretching before activity, avoiding excessive force, and taking frequent breaks within activity.
Acute treatment:
- R.I.C.E.: Rest, Ice, Compression, Elevation:
  - Rest: Avoid any that which may exacerbate symptoms.
  - Ice: Use ice packs in the painful area for 20–30 min 3–4 times/day. May also perform ice massage, which includes freezing water in a Styrofoam or plastic cup, tearing back the sides to the edge of the ice, and rubbing over the affected area.
  - Compression: Wrapping the affected area with an elastic bandage, strap, or brace
  - Elevation: If swelling is present, elevation will help alleviate the swelling.
- Anti-inflammatories are also a mainstay of therapy. Ibuprofen 2 or 3 times/day, or other NSAIDs, may reduce the inflammatory process and hasten healing.

P.607

Medication

Anti-inflammatories: NSAIDs (ibuprofen, etodolac)

Additional Treatment

Referral

If history, physical exam, or other imaging studies suggest signs of tendon rupture, including profound weakness with elbow extension, referral to orthopedic surgery is necessary for potential surgical intervention (2)[B].
For high-risk patients, physical therapy may be beneficial to ensure proper form and stretching.

Additional Therapies

Special considerations:
- Limit ice to 20 min 3 or 4 times daily to avoid cubital tunnel damage of the ulnar nerve.
Rehabilitation:
- Graduated stretching and strengthening following period of rest
- French stretch: (1) Clasp fingers together with hands above head; (2) keep elbows close to head; (3) reach down behind head attempting to touch back; (4) hold, then repeat
- French press: As with stretch, except holding a dumbbell
- Towel stretch: (1) Injured arm overhead with uninjured reaching behind back; (2) one end of towel in each hand; (3) pull, hold, and repeat

Surgery/Other Procedures

Rare, but operative treatment described with elliptical resection of diseased tissue

Ongoing Care

Follow-Up Recommendations

Return to sport/activity when no longer tender at or above tendon insertion, strength regained, and full range of motion

References

1. Vidal AF, Drakos MC, Allen AA. Biceps tendon and triceps tendon injuries. Clin Sports Med. 2004;23:707–722, xi.

2. Blankstein A, Ganel A, Givon U, et al. Ultraschall Med. 2006.

3. Rineer CA, Ruch DS. Elbow tendinopathy and tendon ruptures: epicondylitis, biceps and triceps ruptures. J Hand Surg [Am]. 2009;34:566–576.

Codes

ICD9

727.09 Other synovitis and tenosynovitis