summary Triceps Ruptures are rare injuries to the elbow extensor mechanism that most commonly occurs as a result of a sudden forceful elbow contraction in weightlifters or older males with underlying systemic illness. Diagnosis can be made clinically with the inability to extend the elbow against resistance. MRI studies can help discern between partial and complete tears. Treatment is either immobilization or primary repair depending on patient age, patient underlying systemic disease, chronicity of injury and patient activity demands. Epidemiology Incidence accounts for 0.8% of tendon ruptures Demographics more common in males 2:1 age 30-50 most common commonly seen in competitive weightlifting body building football players Risk factors systemic illness (hyperparathyroidism, renal osteodystrophy, OI, RA, type I DM) anabolic steroid use local steroid injection fluoroquinolone use chronic olecranon bursitis previous triceps surgery Marfan syndrome Etiology Pathophysiology mechanism of injury results from forceful eccentric contraction or FOOSH pathoantomy rupture most commonly occurs at the osseous insertion of the medial or lateral head login to view 1 more bullet Anatomy Triceps brachii pennate muscle comprised of 3 heads lateral login to view 1 more bullet long login to view 1 more bullet medial login to view 1 more bullet insertion occurs over a wide area/footprint inserts on average 1.1 cm distal to the tip of the olecranon width ranges from 1.9-4.2cm consists of login to view 7 more bullets only muscle in the posterior compartment of the arm innervated by radial nerve (C6-C8) Classification No formal classification system exists Can describe the characteristics of the rupture degree of tear complete partial intact location of tear muscle belly musculotendinous junction tendinous insertion avulsion integrity of lateral expansion intact torn Presentation History patients often note a painful pop Physical exam inspection pain, swelling, and ecchymosis over the posterior aspect of the elbow may have palpable defect motion inability to extend elbow against resistance login to view 1 more bullet provocative tests modified Thompson squeeze test login to view 3 more bullets Imaging Radiographs recommended views AP lateral findings may show "flake sign" on lateral view MRI indications useful for determining location and severity findings partial rupture login to view 1 more bullet complete rupture login to view 1 more bullet Treatment Non-operative splint immobilization indications login to view 2 more bullets techniques login to view 1 more bullet Operative primary surgical repair indications login to view 2 more bullets technique login to view 5 more bullets Techniques Primary surgical repair approach posterolateral approach techniques based of location of tear login to view 11 more bullets post-op immobilization in 30-45 degrees of flexion for 2 weeks active ROM initiated at 4 weeks avoid weightlifting for 4-6 months complications specific to this treatment olecranon bursitis flexion contractures re-rupture Complications Elbow stiffness/weakness Ulnar nerve injury Failure of repair