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Figueiredo EA, Lara PHS, Patriota G, Roncetti Júnior R, Belangero PS, Ejnisman B. Partial Rupture of the Distal Triceps in an Athlete: Case Report and Description of Surgical Technique. Rev Bras Ortop 2019; 54:601-604. [PMID: 31686716 PMCID: PMC6819156 DOI: 10.1016/j.rbo.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 11/09/2017] [Indexed: 11/27/2022] Open
Abstract
Brachial triceps tendon ruptures account for less than 1% of all upper limbs tendinous ruptures. Partial ruptures are underdiagnosed, and a partial rupture may become a total lesion. Complete ruptures usually require surgical treatment; however, there is no well-defined conduct for partial ruptures. This article presents the case of a 42-year-old male jiu-jitsu athlete with partial rupture of the brachial triceps who underwent surgical treatment due to persistent loss of elbow extension strength, even after conservative treatment. The repair was performed with grafting of the long palmar muscle tendon, using a technique developed by the authors. No complications were observed, and the patient presented a satisfactory result, evidenced by the improvement in the parameters of isokinetic studies, which were performed before surgery and at 5 months postoperatively. This technique has proven to be an option for cases of partial rupture of the brachial triceps in patients with high physical demand who do not show improvement with the conservative treatment.
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Affiliation(s)
- Eduardo Antônio Figueiredo
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Paulo Henrique Schmidt Lara
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Gyoguevara Patriota
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Ronaldo Roncetti Júnior
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Paulo Santoro Belangero
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
| | - Benno Ejnisman
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (Unifesp), São Paulo, SP, Brasil
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Dunn JC, Kusnezov N, Fares A, Kilcoyne K, Garcia E, Orr JD, Waterman BR. Outcomes of Triceps Rupture in the US Military: Minimum 2-Year Follow-up. Hand (N Y) 2019; 14:197-202. [PMID: 29199471 PMCID: PMC6436132 DOI: 10.1177/1558944717745499] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND The objective of this study was to examine the subjective and objective midterm functional clinical outcomes of surgically repaired triceps injuries in a moderate- to high-demand population. METHODS The US Military Health System was queried to identify all surgically treated triceps tendon ruptures between 2008 and 2013. Primary endpoints included rates of rerupture, perioperative complications, or significant persistent elbow dysfunction; Disability of the Arm, Shoulder and Hand (DASH) score, Mayo Elbow score, and ability to do push-ups were also extracted. RESULTS Thirty-seven patients underwent triceps tendon repair with a mean follow-up of 49.8 ± 17.3 months (range: 26.8-80.2). The most common mechanisms of injury were military duties (27%), sporting activity (24%), or fall-related (21.6%), with most injuries occurring during an eccentric movement (54%). While 45% experienced occasional elbow pain postoperatively, only 1 patient (2.7%) had a rerupture. Despite this, at 2 years, 31 patients (84%) were able to return to full military duty. While 6 patients were discharged from military service, only 1 underwent medical separation while 5 retired for reasons unrelated to their triceps tendon rupture. Patient-reported outcomes were available for 14 patients at final follow-up. The average DASH and Mayo Elbow scores were 4.7 (SD ± 4.7, range: 0-15.9) and 85.4 (SD ± 11.7, range: 60-100), respectively. The cohort could perform mean 54.2 (range: 9-90) push-ups. In additional, 12 of 14 (85.7%) were satisfied with their elbow function. CONCLUSIONS The active duty cohort experienced excellent postoperative results with a high rate of return to military duty, despite nearly half of the patients recognizing some degree of activity-related, elbow pain.
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Affiliation(s)
- John C. Dunn
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | | | - Austin Fares
- Creighton University, Omaha, NE, USA,Austin Fares, School of Medicine, Creighton University, 3561 Howard Street, Omaha, NE 68105, USA.
| | - Kelly Kilcoyne
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | | | - Justin D. Orr
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
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Bengtsson V, Berglund L, Aasa U. Narrative review of injuries in powerlifting with special reference to their association to the squat, bench press and deadlift. BMJ Open Sport Exerc Med 2018; 4:e000382. [PMID: 30057777 PMCID: PMC6059276 DOI: 10.1136/bmjsem-2018-000382] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/17/2022] Open
Abstract
Pain and injuries are considered a common problem among elite athletes and recreational lifters performing the squat, bench press and deadlift. Since all three lifts engage multiple joints and expose the lifters’ bodies to high physical demands often several times a week, it has been suggested that their injuries might be related to the excessively heavy loads, the large range of motion during the exercises, insufficient resting times between training sessions and/or faulty lifting technique. However, no previous article has summarised what is known about specific injuries and the injury aetiology associated with the three lifts. Thus, the aim of this narrative review was to summarise what is known about the relationships between the powerlifting exercises and the specific injuries or movement impairments that are common among lifters and recreationally active individuals.
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Affiliation(s)
- Victor Bengtsson
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Lars Berglund
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Umeå School of Sport Sciences, Umeå University, Umeå, Sweden
| | - Ulrika Aasa
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.,Umeå School of Sport Sciences, Umeå University, Umeå, Sweden.,Medfit, Primary Care Rehabilitation and Fitness Centre, Stockholm, Sweden
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Dunn JC, Kusnezov N, Fares A, Rubin S, Orr J, Friedman D, Kilcoyne K. Triceps Tendon Ruptures: A Systematic Review. Hand (N Y) 2017; 12:431-438. [PMID: 28832209 PMCID: PMC5684929 DOI: 10.1177/1558944716677338] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Triceps tendon ruptures (TTR) are an uncommon injury. The aim of this systematic review was to classify diagnostic signs, report outcomes and rerupture rates, and identify potential predisposing risk factors in all reported cases of surgical treated TTR. METHODS A literature search collecting surgical treated cases of TTR was performed, identifying 175 articles, 40 of which met inclusion criteria, accounting for 262 patients. Data were pooled and analyzed focusing on medical comorbidities, presence of a fleck fracture on the preoperative lateral elbow x-ray film (Dunn-Kusnezov Sign [DKS]), outcomes, and rerupture rates. RESULTS The average age of injury was 45.6 years. The average time from injury to day of surgery was 24 days while 10 patients had a delay in diagnosis of more than 1 month. Renal disease (10%) and anabolic steroid use (7%) were the 2 most common medical comorbidities. The DKS was present in 61% to 88% of cases on the lateral x-ray film. Postoperatively, 89% of patients returned to preinjury level of activity, and there was a 6% rerupture rate at an average follow-up of 34.6 months. The vast majority (81%) of the patients in this review underwent repair via suture fixation. CONCLUSIONS TTR is an uncommon injury. Risks factors for rupture include renal disease and anabolic steroid use. Lateral elbow radiographs should be scrutinized for the DKS in patients with extension weakness. Outcomes are excellent following repair, and rates of rerupture are low.
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Affiliation(s)
- John C. Dunn
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | | | - Austin Fares
- Creighton University, Omaha, NE, USA,Austin Fares, School of Medicine, Creighton University, 3561 Howard Street, Omaha, NE 68105, USA.
| | - Sydney Rubin
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Justin Orr
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
| | - Darren Friedman
- New York Presbyterian Hospital-Weill Cornell Medical College, NY, USA
| | - Kelly Kilcoyne
- William Beaumont Army Medical Center, Fort Bliss, TX, USA
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Kanayama G, DeLuca J, Meehan WP, Hudson JI, Isaacs S, Baggish A, Weiner R, Micheli L, Pope HG. Ruptured Tendons in Anabolic-Androgenic Steroid Users: A Cross-Sectional Cohort Study. Am J Sports Med 2015; 43:2638-44. [PMID: 26362436 PMCID: PMC5206906 DOI: 10.1177/0363546515602010] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Accumulating case reports have described tendon rupture in men who use anabolic-androgenic steroids (AAS). However, no controlled study has assessed the history of tendon rupture in a large cohort of AAS users and comparison nonusers. HYPOTHESIS Men reporting long-term AAS abuse would report an elevated lifetime incidence of tendon rupture compared with non-AAS-using bodybuilders. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Medical histories were obtained from 142 experienced male bodybuilders aged 35 to 55 years recruited in the course of 2 studies. Of these men, 88 reported at least 2 years of cumulative lifetime AAS use, and 54 reported no history of AAS use. In men reporting a history of tendon rupture, the circumstances of the injury, prodromal symptoms, concomitant drug or alcohol use, and details of current and lifetime AAS use (if applicable) were recorded. Surgical records were obtained for most participants. RESULTS Nineteen (22%) of the AAS users, but only 3 (6%) of the nonusers, reported at least 1 lifetime tendon rupture. The hazard ratio for a first ruptured tendon in AAS users versus nonusers was 9.0 (95% CI, 2.5-32.3; P < .001). Several men reported 2 or more independent lifetime tendon ruptures. Interestingly, upper-body tendon ruptures occurred exclusively in the AAS group (15 [17%] AAS users vs 0 nonusers; risk difference, 0.17 [95% CI, 0.09-0.25]; P < .001 [hazard ratio not estimable]), whereas there was no significant difference between users and nonusers in risk for lower-body ruptures (6 [7%] AAS users, 3 [6%] nonusers; hazard ratio, 3.1 [95% CI, 0.7-13.8]; P = .13). Of 31 individual tendon ruptures assessed, only 6 (19%) occurred while weightlifting, with the majority occurring during other sports activities. Eight (26%) ruptures followed prodromal symptoms of nonspecific pain in the region. Virtually all ruptures were treated surgically, with complete or near-complete ultimate restoration of function. CONCLUSION AAS abusers, compared with otherwise similar bodybuilders, showed a markedly increased risk of tendon ruptures, particularly upper-body tendon rupture.
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Affiliation(s)
- Gen Kanayama
- Biological Psychiatry Laboratory, McLean Hospital, Belmont,
Massachusetts, and the Department of Psychiatry, Harvard Medical School, Boston, MA,
USA
| | - James DeLuca
- Division of Cardiology, Massachusetts General Hospital,
Boston, MA and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - William P. Meehan
- Division of Sports Medicine, Boston Children’s
Hospital Hospital, Boston, MA and Harvard Medical School, Boston, MA, USA
| | - James I. Hudson
- Biological Psychiatry Laboratory, McLean Hospital, Belmont,
Massachusetts, and the Department of Psychiatry, Harvard Medical School, Boston, MA,
USA
| | - Stephanie Isaacs
- Division of Cardiology, Massachusetts General Hospital,
Boston, MA and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Aaron Baggish
- Division of Cardiology, Massachusetts General Hospital,
Boston, MA and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Rory Weiner
- Division of Cardiology, Massachusetts General Hospital,
Boston, MA and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lyle Micheli
- Division of Sports Medicine, Boston Children’s
Hospital Hospital, Boston, MA and Harvard Medical School, Boston, MA, USA
| | - Harrison G. Pope
- Biological Psychiatry Laboratory, McLean Hospital, Belmont,
Massachusetts, and the Department of Psychiatry, Harvard Medical School, Boston, MA,
USA
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Abstract
In caring for athletes, the physician must be able to accurately diagnose and appropriately treat all forms of elbow injuries. Traumatic injuries to the elbow are common in the athlete. The late cocking phase of throwing produces tremendous valgus stress on the elbow that can lead to medial epicondyle avulsion fractures in adolescents or rupture of the medial ulnar collateral ligament in skeletally mature overhead throwers, such as baseball pitchers and javelin throwers. Common traumatic elbow injuries suffered by athletes, surgical techniques for operative repair of these injuries, as well as postoperative rehabilitation protocols and the clinical results are presented.
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Affiliation(s)
- Lauren H Redler
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, 535 East 70th Street, New York, NY 10021, USA.
| | - Joshua S Dines
- Hospital for Special Surgery, Sports Medicine and Shoulder Service, 535 East 70th Street, New York, NY 10021, USA
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Celli A. Triceps tendon rupture: the knowledge acquired from the anatomy to the surgical repair. Musculoskelet Surg 2015; 99 Suppl 1:S57-S66. [PMID: 25957546 DOI: 10.1007/s12306-015-0359-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/02/2015] [Indexed: 06/04/2023]
Abstract
Triceps injuries are relatively uncommon in most traumatic events, and the distal triceps tendon ruptures are rare. Recently, the knowledge of this tendon lesion has increased, and it seems to be related to more precise diagnostic and clinical assessments. The most common mechanism of injury remains a forceful eccentric contraction of the muscle, while several other risk factors have been studied as chronic renal failure, endocrine disorders, metabolic bone diseases as well as steroid use. Olecranon bursitis and local corticosteroid injections may also play a role. The commonest site of rupture is at the tendon's insertion into the olecranon and rarely at the myotendinous junction or intramuscularly. The surgical intervention is recommended in acute complete ruptures, and non-operative treatment is reserved for patients with major comorbidities, as well as for partial ruptures with little functional disability and in low demanding patients. Various techniques and approaches as the direct repair to bone, the tendon augmentation, the anconeus rotation flap and the Achilles tendon allograft have been proposed for the management of these challenging injuries. The goal of surgical management should be an anatomical repair of the injured tendon by selection of a procedure with a low complication rate and one that allows early mobilization. This manuscript focuses the triceps tendon ruptures starting from the anatomy to the diagnosis and entity of the triceps tendon injuries, as well as the indications and guidelines for the management.
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Affiliation(s)
- A Celli
- Shoulder and Elbow Unit, Department of Orthopaedic Surgery, Hesperia Hospital, Via Emilia Est 380\1, 41124, Modena, Italy.
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Synthetic augmented suture anchor reconstruction for a complete traumatic distal triceps tendon rupture in a male professional bodybuilder with postoperative biomechanical assessment. Case Rep Orthop 2014; 2014:962930. [PMID: 24711944 PMCID: PMC3965944 DOI: 10.1155/2014/962930] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 01/06/2014] [Indexed: 02/07/2023] Open
Abstract
Bodybuilding is a high-risk sport for distal triceps tendon ruptures. Management, especially in high-demanding athletes, is operative with suture anchor refixation technique being frequently used. However, the rate of rerupture is high due to underlying poor tendon quality. Thus, additional augmentation could be useful. This case report presents a reconstruction technique for a complete traumatic distal triceps tendon rupture in a bodybuilder with postoperative biomechanical assessment. A 28-year-old male professional bodybuilder was treated with a synthetic augmented suture anchor reconstruction for a complete triceps tendon rupture of his right dominant elbow. Postoperative biomechanical assessment included isokinetic elbow strength and endurance testing by using multiple angular velocities to simulate the "off-season" and "precompetition" phases of training. Eighteen months postoperatively and after full return to training, the biomechanical assessment indicated that the strength and endurance of the operated elbow joint was fully restored with even higher ratings compared to the contralateral healthy arm. The described reconstruction technique can be considered as an advisable option in high-performance athletes with underlying poor tendon quality due to high tensile strength and lack of donor site morbidity, thus enabling them to restore preinjury status and achieve safe return to sports.
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10
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Scolaro JA, Blake MH, Huffman GR. Triceps tendon reconstruction using ipsilateral palmaris longus autograft in unrecognized chronic tears. Orthopedics 2013; 36:e117-20. [PMID: 23276343 DOI: 10.3928/01477447-20121217-30] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Injury to the distal triceps tendon is uncommon and can be difficult to diagnose, especially when a partial rupture or tear occurs. In situations where an incomplete disruption to the musculotendinous unit occurs, a palpable defect or clear functional loss may not be present. Advanced imaging techniques, such as magnetic resonance imaging or ultrasound, can be used to confirm the diagnosis and define the extent of injury. The treatment of a complete rupture of the distal triceps tendon is repair or reconstruction, whereas the management of a patient with a partial triceps rupture is related to the pain, functional deficit, and expectations of the patient. This article presents 2 patients with chronic, near complete disruptions of the distal triceps tendon. In both patients, surgical reconstruction of the injured tendon was accomplished using ipsilateral palmaris longus autograft. This technique allows the treating surgeon to harvest the graft from the ipsilateral upper extremity. The palmaris autograft is then used to reconstruct the injured portion of the triceps tendon using a Pulvertaft weave technique through the intact triceps tendon and osseous tunnels within the proximal ulna. This technique allows for easy surgical setup and harvest of autograft tendon and provides a structurally sound technique for a tension-free reconstruction of the injured tendon. It also permits early postoperative elbow range of motion, with active elbow extension allowed at 6 weeks. The authors have used this technique successfully in the treatment of chronic partial tears of the distal triceps tendon.
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Affiliation(s)
- John A Scolaro
- Department of Orthopaedic Surgery, University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104, USA
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11
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Abstract
Partial triceps tendon disruptions are a rare injury that can lead to debilitating outcomes if misdiagnosed or managed inappropriately. The clinician should have a high index of suspicion when the mechanism involves a fall onto an outstretched arm and there is resultant elbow extension weakness along with pain and swelling. The most common location of rupture is at the tendon-osseous junction. This case report illustrates a partial triceps tendon disruption with involvement of, primarily, the medial head and the superficial expansion. Physical examination displayed weakness with resisted elbow extension in a flexed position over 90°. Radiographs revealed a tiny fleck of bone proximal to the olecranon, but this drastically underestimated the extent of injury upon surgical exploration. Magnetic resonance imaging is essential to ascertain the percentage involvement of the tendon; it can be used for patient education and subsequently to determine treatment recommendations. Although excellent at finding associated pathology, it may misjudge the size of the tear. As such, physicians must consider associated comorbidities and patient characteristics when formulating treatment plans.
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Affiliation(s)
- David M Foulk
- Cincinnati SportsMedicine and Orthopaedic Center, Cincinnati, Ohio
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12
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Abstract
Context: Elbow tendinopathy is a common cause of pain and disability among patients presenting to orthopaedic surgeons, primary care physicians, physical therapists, and athletic trainers. Prompt and accurate diagnosis of these conditions facilitates a directed treatment regimen. A thorough understanding of the natural history of these injuries and treatment outcomes will enable the appropriate management of patients and their expectations. Evidence Acquisitions: The PubMed database was searched in December 2011 for English-language articles pertaining to elbow tendinopathy. Results: Epidemiologic data as well as multiple subjective and objective outcome measures were investigated to elucidate the incidence of medial epicondylitis, lateral epicondylitis, distal biceps and triceps ruptures, and the efficacy of various treatments. Conclusions: Medial and lateral epicondylitis are overuse injuries that respond well to nonoperative management. Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up. Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis. If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken. Distal biceps and triceps tendon ruptures, in contrast, have an acute traumatic etiology that may be superimposed on underlying tendinopathy. Prompt diagnosis and treatment improve outcomes. While partial ruptures confirmed with magnetic resonance imaging can be treated nonoperatively with immobilization, complete ruptures should be addressed with primary repair within 3 to 4 weeks of injury.
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Distal partial ruptures of triceps brachii tendon in an athlete. Orthop Traumatol Surg Res 2012; 98:242-6. [PMID: 22381568 DOI: 10.1016/j.otsr.2011.09.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 06/24/2011] [Accepted: 09/16/2011] [Indexed: 02/02/2023]
Abstract
Distal brachii triceps tendon rupture is rare. Partial lesions are not so well defined. If functionally they are well tolerated in patients with low functional demand, management guideline is not so clear for sportsmen. To our best knowledge, there is no reported technique for the repair of partial forms. A 28-year-old patient was operated on for a partial triceps rupture. He underwent a transosseous olecranon suture of the tricipital tendon, with a side-to-side suture to the healthy residual tendon. The patient was assessed at 2 years follow-up with the DASH score. He had painless and mobile elbow with no effusion and returned to sport 4 months after his surgical repair. The extension strength was comparable to the healthy side (5/5). The DASH score was 1,7 for global score, and 6,3 for work and sport modules. Partial rupture of brachii triceps tendon is not well tolerated in high functional demand patients. We think that patients should be operated in these situations and may achieve excellent results. Postoperative management is crucial to achieve good results as well as in complete rupture.
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14
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Yoon MY, Koris MJ, Ortiz JA, Papandrea RF. Triceps avulsion, radial head fracture, and medial collateral ligament rupture about the elbow: a report of 4 cases. J Shoulder Elbow Surg 2012; 21:e12-7. [PMID: 22005123 DOI: 10.1016/j.jse.2011.06.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Revised: 06/16/2011] [Accepted: 06/25/2011] [Indexed: 02/01/2023]
Affiliation(s)
- Michele Y Yoon
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
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15
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Koplas MC, Schneider E, Sundaram M. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation. Skeletal Radiol 2011; 40:587-94. [PMID: 20953605 DOI: 10.1007/s00256-010-1043-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 08/10/2010] [Accepted: 09/21/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. MATERIALS AND METHODS From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. RESULTS The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). CONCLUSIONS Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed.
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Affiliation(s)
- Monica C Koplas
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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16
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Petre BM, Grutter PW, Rose DM, Belkoff SM, McFarland EG, Petersen SA. Triceps tendons: a biomechanical comparison of intact and repaired strength. J Shoulder Elbow Surg 2011; 20:213-8. [PMID: 21145757 DOI: 10.1016/j.jse.2010.08.017] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 07/27/2010] [Accepted: 08/07/2010] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Our hypothesis was that the autograft-augmented direct repair of torn triceps tendons would have strength superior than that of direct repair when compared to the strength of intact distal triceps tendons. MATERIALS AND METHODS The strength of the intact distal triceps tendon in 8 unpaired, fresh frozen cadaver specimens was measured to tendon failure by uniaxial tension in the sagittal plane. The torn triceps tendons were then repaired by direct repair (sutures through drill holes) or an autograft-augmented direct repair. Each tendon repair was biomechanically tested to failure, and load to displacement curves and the site of tendon failure were recorded. Tendon strength after each repair was compared with that of the other repair technique and with that of the intact triceps tendon. Significance was set at P < .05. RESULTS Average failure loads for intact, direct repair, and augmented repair tendons were 1741, 317, and 593 N, respectively; augmented repairs were significantly stronger than direct repairs. In the intact tendon, failure occurred at the insertion site through a tear at the bone tendon interface or through a small cortical avulsion. In the repaired tendons, all but 1 failure occurred through the suture; 1 augmented repair failed first at the tendon and then through the suture. DISCUSSION There is a paucity of clinical data regarding the optimal repair for distal triceps avulsion. We found that triceps repair affords less strength than the intact tendon, but augmented repair was nearly twice as strong as that of direct repair. Augmented repair may allow earlier range of motion, weightbearing, and rehabilitation, theoretically decreasing complications associated with the procedure. CONCLUSIONS Augmented triceps repair is superior to direct triceps repair for a distal triceps avulsion produced in a cadaver model.
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Affiliation(s)
- Benjamin M Petre
- International Center for Orthopaedic Advancement and Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA
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17
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Koplas MC, Schneider E, Sundaram M. Prevalence of triceps tendon tears on MRI of the elbow and clinical correlation. Skeletal Radiol 2010. [PMID: 20953605 DOI: 10.1007/s00256- 010-1043-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Triceps tendon injuries are reported to be very rare. To our knowledge, there have been no studies describing its prevalence or injury patterns on MR imaging. The purpose of this retrospective study was to determine the prevalence and patterns of triceps injuries based on a large series of consecutive MR examinations. Clinical correlation was obtained. MATERIALS AND METHODS From 801 consecutive elbow MR examinations over a 15-year period, 28 patients with 30 triceps tendon injuries were identified and graded as partial tendon tear and complete tendon tear. The patients' medical records were reviewed to determine age, gender, cause of tears, and management. RESULTS The prevalence of triceps tendon injuries was 3.8%. There were 5 women and 23 men with partial or complete tears (mean age: 46.6 years; range: 2.7 to 75.1 years). The most common injury was partial tear, found in 18 patients. There were 10 patients with 12 complete tears (2 had re-torn following surgical repair). A tear was suspected in 12 out 28 (43%) patients prior to the MRI. The most common presenting symptom was pain. The most common cause was athletic injury (8 patients [29%], including weightlifting [2 patients]). Tendon tear was found to be a complication of infection in 6 patients, and in 3 patients the tears were a complication of steroid use. Thirteen tendon tears were surgically repaired (8 of these were complete tears). CONCLUSIONS Triceps tendon injury is not as rare as commonly reported and may often be clinically underdiagnosed.
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Affiliation(s)
- Monica C Koplas
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS 39216, USA.
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18
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Nikolopoulos DD, Spiliopoulou C, Theocharis SE. Doping and musculoskeletal system: short-term and long-lasting effects of doping agents. Fundam Clin Pharmacol 2010; 25:535-63. [PMID: 21039821 DOI: 10.1111/j.1472-8206.2010.00881.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Doping is a problem that has plagued the world of competition and sports for ages. Even before the dawn of Olympic history in ancient Greece, competitors have looked for artificial means to improve athletic performance. Since ancient times, athletes have attempted to gain an unfair competitive advantage through the use of doping substances. A Prohibited List of doping substances and methods banned in sports is published yearly by the World Anti-Doping Agency. Among the substances included are steroidal and peptide hormones and their modulators, stimulants, glucocorticosteroids, β₂-agonists, diuretics and masking agents, narcotics, and cannabinoids. Blood doping, tampering, infusions, and gene doping are examples of prohibited methods indicated on the List. Apart from the unethical aspect of doping, as it abrogates fair-play's principle, it is extremely important to consider the hazards it presents to the health and well-being of athletes. The referred negative effects for the athlete's health have to do, on the one hand, by the high doses of the performance-enhancing agents and on the other hand, by the relentless, superhuman strict training that the elite or amateur athletes put their muscles, bones, and joints. The purpose of this article is to highlight the early and the long-lasting consequences of the doping abuse on bone and muscle metabolism.
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Affiliation(s)
- Dimitrios D Nikolopoulos
- Department of Forensic Medicine and Toxicology University of Athens, Medical School, Athens, Greece
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19
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Self-reported anabolic-androgenic steroids use and musculoskeletal injuries: findings from the center for the study of retired athletes health survey of retired NFL players. Am J Phys Med Rehabil 2009; 88:192-200. [PMID: 19847128 DOI: 10.1097/phm.0b013e318198b622] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The relationship between musculoskeletal injuries and anabolic-androgenic steroids is not well understood. The purpose of our study was to investigate the association between self-reported anabolic-androgenic steroids use and the prevalence of musculoskeletal injuries in a unique group of retired professional football players. DESIGN A general health questionnaire was completed by 2552 retired professional football players. Survey data were collected between May 2001 and April 2003. Results of self-reported musculoskeletal injuries were compared with the use of anabolic-androgenic steroids using frequency distributions and chi2 analyses. RESULTS Of the retired players, 9.1% reported using anabolic-androgenic steroids during their professional career. A total of 16.3% of all offensive line and 14.8% of all defensive line players reported using anabolic-androgenic steroids. Self-reported anabolic-androgenic steroids use was significantly associated (P < 0.05) with the following self-reported, medically diagnosed, joint and cartilaginous injuries in comparison with the nonanabolic-androgenic steroids users: disc herniations, knee ligamentous/meniscal injury, elbow injuries, neck stinger/burner, spine injury, and foot/toe/ankle injuries. There was no association between anabolic-androgenic steroids use and reported muscle/tendon injuries. CONCLUSIONS Our findings demonstrate that an association may exist between anabolic-androgenic steroids use and the prevalence of reported musculoskeletal injury sustained during a professional football career, particularly ligamentous/joint-related injuries. There may also be an associated predisposition to selected types of injuries in anabolic-androgenic steroids users.
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20
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21
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Sierra RJ, Weiss NG, Shrader MW, Steinmann SP. Acute triceps ruptures: case report and retrospective chart review. J Shoulder Elbow Surg 2006; 15:130-4. [PMID: 16414484 DOI: 10.1016/j.jse.2005.01.004] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Accepted: 01/29/2005] [Indexed: 02/01/2023]
Affiliation(s)
- Rafael J Sierra
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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22
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Abstract
Injuries to the biceps and triceps tendons about the elbow are relatively infrequent. Typically, they are traumatic events that occur as a result of a forceful eccentric contraction. Early recognition of these injuries and prompt intervention are the cornerstones to a successful outcome. Acute anatomic repair of complete injuries offers predictably good results. Conservative management, on the other hand, is typically reserved for partial injuries with little functional compromise, and for patients unfit for surgery. The challenges posed by chronic injuries can be addressed with a variety of surgical options. This article focuses on the timely identification and diagnosis of these injuries and specific indications and guidelines for their treatment.
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Affiliation(s)
- Armando F Vidal
- The Sports Medicine and Shoulder Service, The Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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23
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Harris PC, Atkinson D, Moorehead JD. Bilateral partial rupture of triceps tendon: case report and quantitative assessment of recovery. Am J Sports Med 2004; 32:787-92. [PMID: 15090398 DOI: 10.1177/0363546503258903] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Peter Christian Harris
- Department of Trauma and Orthopaedic Surgery, University Hospital Aintree, Lower Lane, Aintree, Liverpool, L9 7AL, United Kingdom
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24
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Abstract
BACKGROUND Distal triceps tendon ruptures occur rarely, and the diagnosis is often missed when the injury is acute. The literature provides little guidance regarding treatment or the outcome of treatment of these injuries. The goal of this report was to present our experience with the diagnosis, timing and technique of surgical treatment, and outcome of treatment of distal triceps tendon ruptures in twenty-two patients. None of the ruptures followed joint replacement. METHODS Twenty-three procedures were performed in twenty-two patients with an average age of forty-seven years. The average duration of follow-up was ninety-three months (range, seven to 264 months). Data were obtained by a retrospective review of records and radiographs before and after surgery. Also, thirteen patients returned for follow-up and were examined clinically. Six additional patients responded to a telephone questionnaire. One patient was lost to follow-up, and two had died. Formal biomechanical evaluation of isokinetic strength and isokinetic work was performed in eight patients, at an average of eighty-eight months after surgery. Isokinetic strength data were available from the charts of two additional patients. RESULTS Ten of the triceps tendon ruptures were initially misdiagnosed. At the time of diagnosis, triceps weakness with a decreased active range of motion was found in most patients, and a palpable defect in the tendon was noted after sixteen ruptures. Operative findings revealed a complete tendon rupture in eight cases and partial injuries in fifteen. Fourteen primary repairs and nine reconstructions of various types were performed. Three of the primary repairs were followed by rerupture. At the time of follow-up, the range of elbow motion averaged 10 degrees to 136 degrees. All but two elbows had a functional range of motion; however, the lack of a functional range in the two elbows was probably due to posttraumatic arthritis and not to the triceps tendon rupture. Triceps strength was noted to be 4/5 or 5/5 on manual testing in all examined subjects. Isokinetic testing of ten patients showed that peak strength was, on the average, 82% of that of the untreated extremity. Testing showed the average endurance of the involved extremity to be 99% of that of the uninvolved arm. The results after repair and reconstruction were comparable, but the patients' recovery was slower after reconstruction. CONCLUSIONS The diagnosis of distal triceps tendon rupture is often missed when the injury is acute because of swelling and pain. Primary repair of the ruptured tendon is always possible when it is performed within three weeks after the injury. When the diagnosis is in doubt immediately after an injury, the patient should be followed closely and should be reexamined after the swelling and pain have diminished so that treatment can be instituted before the end of this three-week period. Reconstruction of the tendon is a much more complex, challenging procedure, and the postoperative recovery is slower. Thus, we believe that early surgical repair, within three weeks after the injury, is the treatment of choice for distal triceps tendon ruptures. of evidence.
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Affiliation(s)
- Roger P van Riet
- Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55902, USA
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26
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27
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Abstract
The elbow is a commonly injured joint, yet physicians may be less comfortable treating injuries to the elbow compared with knee and shoulder injuries. Common injuries involving the elbow are tendinosis, instability, tendon ruptures, osteochondritis dissecans, and fractures. Tendinosis is a common overuse injury and may occur on the lateral, medial, or infrequently, the posterior side of the elbow. Injury to the medial or lateral ulnar collateral ligaments may result in instability. Repetitive trauma from overuse is the most common etiologic factor in athletes. Distal biceps and triceps tendon injuries may result in elbow disability in active individuals. Partial tears are more difficult to diagnose than complete ruptures. Osteochondritis dissecans of capitellum affects adolescents involved in overhead throwing athletics. Fractures about the elbow most commonly involve the radial head in adults, and the distal humerus in children. Athletes are prone to elbow injuries resulting from both overuse and acute trauma. Our purpose is to describe the diagnosis and treatment of these common elbow injuries in athletes of all ages.
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Affiliation(s)
- Utku Kandemir
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15203, USA
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28
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Abstract
Most injuries sustained during strength training are mild strains that resolve with appropriate rest. More severe injuries include traumatic shoulder dislocations, tendon ruptures of the pectoralis major, biceps, and triceps; stress fractures of the distal clavicle, humerus, radius, and ulna; traumatic fractures of the distal radius and ulna in adolescent weightlifters; and compressive and stretch neuropathies. These more severe injuries are usually the result of improperly performing a strength training exercise. Educating athletes regarding proper strength-training techniques serves to reverse established injury patterns and to prevent these injuries in the first place. Recognizing the association of anabolic steroid use to several of the injury patterns further reinforces the need for medical specialists to counsel athletes against their use. With the increasing use of supplements such as creatine, the incidence and nature of strength-training injuries may change further. Greater emphasis on the competitive performance of younger athletes undoubtedly will generate enthusiasm for strength training at earlier ages in both sexes. The importance of proper supervision of these young athletes by knowledgeable persons will increase. As the popularity of strength training grows, there will be ample opportunity to continue to catalog the injury patterns associated with this activity.
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Affiliation(s)
- H A Haupt
- Orthopedic Associates, LLC, St. Louis, Missouri, USA
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Abstract
Tendon rupture has been linked with anabolic steroid abuse on the basis of a small number of published case reports. Although experimental data from animal models suggest steroids alter the biomechanical properties of tendon, ultrastructural evidence to support this theory is lacking. Indeed, microscopic analysis of human tendon from steroid users has not previously been reported. In this study, specimens of ruptured human tendon from four patients were biopsied during surgical repair. Two of the subjects were anabolic steroid users, and two subjects were used as nonsteroid-user controls. Ruptured tendon from both groups was examined using electron microscopy. No differences in collagen fibril ultrastructure were seen. We conclude that anabolic steroids did not induce ultrastructural collagen changes that might predispose to tendon rupture in humans.
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Affiliation(s)
- N A Evans
- Department of Orthopaedics, Cardiff Royal Infirmary, U.K
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31
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Abstract
Triceps tendon avulsion injuries are rare. We report four weight lifters with triceps tendon raptures, two of whom had received local steroid injections for pain in the triceps. All four patients had taken oral anabolic steroids before injury. All patients had closed avulsion of the triceps tendon from its insertion into the olecranon. Three patients were injured while bench pressing heavy weights, and one patient was injured while swinging a baseball bat. Satisfactory results were achieved after surgical reinsertion of the tendon.
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Affiliation(s)
- J L Sollender
- Department of Orthopedic Surgery, University of Oklahoma Health Science Center, and Baptist Medical Center, Oklahoma City, USA
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Dickerman RD, McConathy WJ, Smith AB. Can pressure overload cause sliding hiatal hernia? A case report and review of the literature. J Clin Gastroenterol 1997; 25:352-3. [PMID: 9412919 DOI: 10.1097/00004836-199707000-00012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We describe a hiatal hernia of moderate size in a 31-year-old competitive bodybuilder to raise the question of whether such hernias are more likely in young elite resistance-trained athletes as a consequence of attempts to increase intra-abdominal pressure and thus decrease the strain on the lumbar spine.
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Affiliation(s)
- R D Dickerman
- Department of Medicine, University of North Texas Health Science Center, Fort Worth 76107-2699, USA
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33
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Abstract
Rupture of the triceps brachii at the musculotendinous junction is reported in a patient with diabetes mellitus and hypertension. Successful reconstruction was achieved by delayed primary repair. V-Y advancement of the triceps, and a plantaris tendon graft.
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Affiliation(s)
- J R Wagner
- St. Louis University School of Medicine, MO, USA
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Street C, Antonio J, Cudlipp D. Androgen use by athletes: a reevaluation of the health risks. CANADIAN JOURNAL OF APPLIED PHYSIOLOGY = REVUE CANADIENNE DE PHYSIOLOGIE APPLIQUEE 1996; 21:421-40. [PMID: 8959310 DOI: 10.1139/h96-038] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
It has been estimated that 1 to 3 million male and female athletes in the United States have used androgens. Androgen use has been associated with liver dysfunction, altered blood lipids, infertility, musculotendinous injury, and psychological abnormalities. Although androgens have been available to athletes for over 50 years, there is little evidence to show that their use will cause any long-term detriment; furthermore, the use of moderate doses of androgens results in side effects that are largely benign and reversible. It is our contention that the incidence of serious health problems associated with the use of androgens by athletes has been overstated.
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Affiliation(s)
- C Street
- Department of Health and Human Performance, University of Houston, TX 77004, USA
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36
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Abstract
Rupture of the triceps tendon is a rare injury, and clues to diagnosis on physical examination can be masked by pain and swelling. Two cases of triceps tendon rupture are reported in which ultrasonography was used to assist in the diagnosis.
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Affiliation(s)
- F A Kaempffe
- Department of Orthopaedic and Hand Surgery, Myers Community Hospital, Sodus, NY, USA
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37
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Freeman BJ, Rooker GD. Spontaneous rupture of the anterior cruciate ligament after anabolic steroids. Br J Sports Med 1995; 29:274-5. [PMID: 8808545 PMCID: PMC1332242 DOI: 10.1136/bjsm.29.4.274] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Anabolic steroids remain popular among body builders and power athletes despite numerous warning about their side effects. A case of spontaneous rupture of the anterior cruciate ligament is reported in a bodybuilder taking steroids. While there are many published reports of tendon rupture associated with steroid intake, the authors could find no report relating to ligament disruption.
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Affiliation(s)
- B J Freeman
- Department of Orthopaedic Surgery, Cheltenham General Hospital, Gloucestershire, UK
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Abstract
Athletes are generally well educated regarding substances that they may use as ergogenic aids. This includes anabolic steroids and growth hormone. Fortunately, the abuse of growth hormone is limited by its cost and the fact that anabolic steroids are simply more enticing to the athlete. There are, however, significant potential adverse effects regarding its use that can be best understood by studying known growth hormone excess, as demonstrated in the acromegalic syndrome. Many athletes are unfamiliar with this syndrome and education of the potential consequences of growth hormone excess is important in counseling athletes considering its use. While athletes contemplating the use of anabolic steroids may correctly perceive their risks for significant physiologic effects to be small if they use the steroids for brief periods of time, many of these same athletes are unaware of the potential for habituation to the use of anabolic steroids. The result may be incessant use of steroids by an athlete who previously considered only short-term use. As we see athletes taking anabolic steroids for more prolonged periods, we are likely to see more severe medical consequences. Those who eventually do discontinue the steroids are dismayed to find that the improvements made with the steroids generally disappear and they have little to show for hours or even years of intense training beyond the psychological scars inherent with steroid use. Counseling of these athletes should focus on the potential adverse psychological consequences of anabolic steroid use and the significant risk for habituation.
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Affiliation(s)
- H A Haupt
- Orthopaedic Associates, Inc., Missouri Baptist Hospital, Diagnostic Center, St. Louis 63131
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Affiliation(s)
- D S Louis
- Orthopedic Hand Service, University of Michigan, Ann Arbor 48109-0328
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