The triceps is the muscle at the back of the elbow. The function of the triceps is to extend (straighten) the elbow from a bent position. The triceps has three parts (heads) that arise from the back of the humerus and from the scapula (shoulder blade) and insert into the olecranon process of the ulna.
Pain as a result of degeneration of the triceps tendon is seen less frequently than from other tendon units around the elbow. It is most frequently seen in sportsmen who rely on forced elbow extension. It is best managed with physiotherapy, particularly eccentric strengthening exercises. Platelet rich plasma injection may speed up the recovery.
Olecranon Spur (Ossifying Triceps Enthesopathy)
Spurs (bony outgrowths) on the tip of the olecranon are quite common and is most cases do not cause a problem. Occasionally they can become painful and in many instances this is because of fracture of the tip of the bony spur. This can be identified on a CT scan. The treatment is surgical excision of the broken fragment of bone. The spur may be removed at the same time as long as this does not compromise the triceps insertion strength. Application of a static extension splint for two weeks is recommended to avoid problems of wound healing over the point of the elbow.
Triceps Tendon Rupture
This is a very rare condition. It occurs most commonly after total elbow arthroplasty and in this situation may go unrecognised as gravity will do much of the work of elbow extension. Traumatic distal triceps avulsion occurs most commonly in contact sports. A history of pain, swelling and bruising at the back of the elbow after a forced flexion in an extended elbow would raise the possibility of triceps avulsion. The elbow should be examined with the patient lying supine with the shoulder flexed to 90 degrees. The strength of elbow extension can then be assessed while the examiner feels the tendon for a defect.
Various techniques are described for repair of the distal triceps. Anatomical footprint repair is the most favoured technique for acute ruptures (within three weeks of injury) with transosseous sutures or suture anchors. For delayed ruptures hamstring grafts taken from the patients own thigh or donor grafts can be used. An anconeus slide technique has been described but is less commonly used.