CHAPTER 16 Arthroscopic Triceps Repair
Injuries to the triceps tendon were once thought to occur only in patients performing extremely heavy lifting exercises or those using supplementation to artificially enhance their ability to perform these types of exercises. However, as our population has aged and attempted to maintain an extremely active lifestyle, many such injuries have become more commonplace in the average population. The increased number of older, more active individuals has increased the incidence of injury to the triceps.
The triceps tendon takes its name from the three sites of its origin from the humerus and inferior glenoid. The triceps muscle courses distally along the posterior aspect of the humerus to insert in a fanlike fashion on the proximal and posterior aspects of the olecranon process of the ulna. The insertion lies beneath the olecranon bursa and blends with the forearm muscle origins arising from the ulna. The main function of the triceps is to extend the elbow. Injuries to the triceps muscle-tendon unit may take many forms, including partial or complete avulsion from the bone, intrasubstance tears, and muscle-tendon junction tears.
Most patients have experienced pain or a “pop” when performing a press-type activity or after a fall on an outstretched and slightly flexed elbow. In heavy-weight lifters, this usually occurs during a bench press activity, with resultant loss of control of the bar. In less active individuals, it can occur while pushing up from a seated position. Partial tears may begin with a subtle pain noticed in the beginning of extension from a fully flexed position. Dips and overhead triceps extension exercises, as often performed in body pump or weight-lifting classes, may represent the first time a patient begins to notice pain in the back of the elbow. This is especially true in cases of degenerative, dysvascular tear patterns.
The physical examination begins with observation for swelling or ecchymosis (Fig. 16-1). Patients with complete tears may have a complete loss of the ability to extend the elbow, whereas those with partial or degenerative tears may retain active extension but in a weakened state. In those with the more subtle tears, trying to extend the elbow from a fully flexed position reproduces pain directly over the site of the injury (i.e., triceps stress test), which can then be palpated for a defect.