(Kiosk 2) Got Triceps? Acute Rupture After a Fall: A Case Report

Case Diagnosis: Traumatic triceps brachii tendon tear

Case Description or Program Description: A 63-year-old male with a history of gout presented to an outpatient practice with 3 weeks of posterior left distal arm pain and weakness after falling on stairs and attempting to catch himself. He experienced a “pop” sensation at the posterior left elbow followed by significant bruising, edema, and weakness with elbow extension. His exam demonstrated swelling and tenderness at the distal tendon insertion without frank palpable defect, in addition to pain and weakness with resisted elbow extension.

Setting: Outpatient non-surgical musculoskeletal clinic

Assessment/Results: MRI demonstrated a high-grade tear of the long and lateral heads of the triceps with 3.8cm of tendon retraction. He was promptly referred for surgical repair. Three months post-operatively he demonstrated full painless range of motion and began progressive return to weightlifting.

Discussion (relevance): Triceps tendon tears account for less than 2% of all tendon injuries and less than 1% within the upper extremity. They typically occur during periods of eccentric overload seen with weightlifting, football, or falls onto an outstretched arm. Patients with full-thickness injuries often present with a direct mechanism of injury followed by pain, weakness, and sometimes a palpable defect at the distal tendon insertion. Evaluators typically have low clinical suspicion in the acute setting and the diagnosis can easily be missed or delayed due to exam limitations from acute pain and edema.

Conclusions: Our patient was otherwise healthy; however, chronic kidney disease and prolonged steroid use are comorbidities that may increase the risk of tendon rupture. Radiographs are useful to identify fleck avulsion fractures at the distal insertion site while ultrasound and MRI allow for better evaluation of tendon integrity and surgical candidacy. It is essential to consider a triceps tendon rupture when evaluating posterior elbow pain as early surgical repair is associated with improved outcomes.