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Introduction
  • Epidemiology
    • demographics
      • usually males
      • age 30-50 most common
      • commonly seen in
        • competitive weightlifting
        • body building
        • football players
    • risk factors 
      • systemic illness (renal osteodystrophy)
      • anabolic steroid use
      • local steroid injection 
      • flouroquinolone use
      • chronic olecranon bursitis
      • previous triceps surgery
  • Pathophysiology
    • mechanism
      • usually forceful eccentric contraction
    • pathoanatomy
      • rupture most common at the insertion of medial or lateral head
      • less frequently through muscle belly or musculotendinous junction
Presentation
  • History
    • patients often note a painful pop
  • Symptoms
    • loss of ability to extend elbow against gravity
  • Physical exam
    • may have palpable gap
    • swelling, ecchymosis, and pain
Imaging
  • Radiographs
    • recommended views
      • AP/lateral of elbow
    • findings
      • may show "flake sign" on lateral view  
  • MRI
    • useful for determining location and severity 
Treatment
  • Non-operative
    • supportive treatment
      • indications
        • partial tears and able to extend against gravity
        • low demand patients in poor health
  • Operative
    • primary surgical repair
      • indications
        • acute complete tears
        • partial tears (>50%) with significant weakness
      • technique
        • delayed reconstruction may need tendon graft 
Complications
  • Elbow stiffness
  • Ulnar nerve injury
  • Failure of repair
 

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