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Distal biceps tendon rupture
1%
74/5169
Brachialis muscle rupture
0%
12/5169
Lateral ulnar collateral ligament tear
39/5169
Medial ulnar collateral ligament tear
28/5169
Triceps tendon tear
97%
4993/5169
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The lateral radiograph shows a "flake sign" which is common in patients with a triceps tendon avulsion, as suggested by this clinical scenario. Triceps tendon tears occur most commonly in males age 30-50, and those involved in competitive weightlifting and football. There is an established link with anabolic steroid use. Other risk factors include renal disease, corticosteroids, history of tendon injection, and fluroquinolone antibiotics. Surgical repair is indicated in active persons with complete tears and for incomplete tears with concomitant loss of strength. Yeh et al note the importance of obtaining radiographs and that the flake sign is pathognomonic of a triceps tendon avulsion. They note that an MRI is often used to confirm the diagnosis, classify the injury, and guide management. van Riet et al reported a case series of triceps tendon ruptures. Making the correct diagnosis is important because primary repair is possible within 3 weeks and affords better results than late reconstruction. A high clinical suspicion and use of imaging is critical, as 10 of their 23 ruptures were missed on initial presentation. Illustration A: MRI showing the ruptured triceps tendon on this patient. Illustration B: Intra-operative photo during the subsequent repair with sutures being pulled through bone tunnels.
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