Reconstruction of chronic tearing of the distal triceps using the double-row configuration: technical note

Arthroscopic Treatment in the Distal Rupture of the Triceps Brachial Tendon in Elite Athlete: A Case Report

Injuries (rupture, avulsion) of the triceps tendon are considered infrequent injuries, which mainly affect the male gender and are directly associated with injuries that occur during sports and in a high percentage due to the consumption of steroids. The diagnosis and treatment must be carried out early, especially in those patients with high functional demand or elite athletes, in order to obtain good functional results. The clinical examination should be accompanied by diagnostic imaging studies. There is conservative treatment for lesions affecting less than 50% of the tendon, but those lesions that compromise over 50% of the tendon, surgical treatment is the indication. It could be performed through an open approach or via arthroscopic (barely described in the literature). The time of injury is the key point the early surgical treatment has shown to have optimal outcomes. However, there is no consensus on the surgical approach and its functional outcome.

Redirection Using Double Pulley Technique for Snapping Triceps Tendon: A Case Report and Technique Note

Background

Snapping triceps tendon is an increasingly recognized clinical entity, which is associated with a variety of pathologic factors. The causative factors include inherited structural or developmental variations, post‐traumatic malalignment, and other reasons. The main complaint of patients with snapping lateral triceps are the snapping sensation, mild muscle weakness of elbow extension, with or without tenderness in distal triceps tendon. Many treatment options have been reported previously, including tendon resection and redirection.

Case presentation

We present the case of a 19‐year‐old boy with post‐traumatic distal lateral head of triceps tendon dislocation who complained of extension weakness and snapping sensation in his left elbow. Then, we used two‐strand‐overhand locking (TSOL) knot combined with double pulley technique to redirect the snapping triceps tendon.

Conclusion

The patient recovered well after the operation without complaining of discomfort. This fixing and redirection tendon technique, described previously for repairing rotator cuff tears, may be applied in a similar fashion for the snapping triceps tendon with promising clinical results.

Surgical Repair of Distal Triceps Tendon Injuries: Short-term to Midterm Clinical Outcomes and Risk Factors for Perioperative Complications

Background

Few large-scale series have described functional outcomes after distal triceps tendon repair. Predictors for operative success and a comparative analysis of surgical techniques are limited in the reported literature.

Purpose

To evaluate short-term to midterm functional outcomes after distal triceps tendon repair in a broad patient population and to comparatively evaluate patient-reported outcomes in patients with and without pre-existing olecranon enthesopathy while also assessing for modifiable risk factors associated with adverse patient outcomes and/or revision surgery.

Study Design

Case series; Level of evidence, 4.

Methods

This study was a retrospective analysis of 69 consecutive patients who underwent surgical repair of distal triceps tendon injuries at a single institution. Demographic information, time from injury to surgery, mechanism of injury, extent of the tear, pre-existing enthesopathy, perioperative complications, and validated patient-reported outcome scores were included in the analysis. Patients with a minimum of 1-year follow-up were included.

Results

The most common mechanisms of injury were direct elbow trauma (44.9%), extension/lifting exercises (20.3%), overuse (17.4%), and hyperflexion or hyperextension (17.4%). Eighteen patients were identified with pre-existing symptomatic enthesopathy, and 51 tears were caused by an acute injury. A total of 36 complete and 33 partial tendon tears were identified. Bone tunnels were most commonly used (n = 30; 43.5%), while direct sutures (n = 23; 33.3%) and suture anchors (n = 13; 18.8%) were also used. Perioperative complications occurred in 21.7% of patients, but no patients experienced a rerupture at the time of final follow-up. No statistically significant relationship was found between patient age (P = .750), degree of the tear (P = .613), or surgical technique employed (P = .608) and the presence of perioperative complications.

Conclusion

Despite the heightened risk of perioperative complications after primary repair of distal triceps tendon injuries, the current series found favorable functional outcomes and no cases of reruptures at short-term to midterm follow-up. Furthermore, age, surgical technique, extent of the tear, and mechanism of injury were not associated with adverse patient outcomes in this investigation. Pre-existing triceps enthesopathy was shown to be associated with increased complication rates.

Distal triceps injuries (including snapping triceps): A systematic review of the literature

AIM

To review current literature on types of distal triceps injury and determine diagnosis and appropriate management.

METHODS

We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10^th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format.

RESULTS

Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4^th-5^th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical management includes resection of triceps edge or transposition of the tendon plus or minus ulna nerve transposition.

CONCLUSION

Distal triceps injuries are uncommon. This systematic review examines the evidence base behind diagnosis, imaging and treatment options of distal triceps injuries including tears and snapping triceps.