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Musculoskeletal and Sports Medicine

Complete Triceps Brachii Tear Following Fall on to Outstretched Hand: A Case Report

Thursday, November 16, 2023

    Primary Author(s)

  • Evan H. Chung, MD

    Resident Physician
    Rutgers New Jersey Medical School PM&R Program
    West Orange, New Jersey

    • Co-Author(s)

  • NS

    Nigel Shenoy, MD

    Attending Physician, Clinical Assistant Professor
    Rutgers New Jersey Medical School PM&R Program
    East Orange, New Jersey

Case Diagnosis: Complete tear of the right triceps brachii tendon

Case Description or Program Description: Patient presented from the Emergency Department (ED) for evaluation of pain in the right elbow, left shoulder and knee after tripping over a ladder and falling onto outstretched hands (FOOSH). Imaging studies of the upper extremities in the ED were negative for fractures or dislocations but right elbow imaging demonstrated soft tissue swelling and edema in the posterior elbow region. In clinic, the patient endorsed persistent pain predominantly in the right lateral elbow but also in the left medial forearm and left shoulder.

Setting: Outpatient Clinic

Assessment/Results: Physical exam of the right upper extremity demonstrated significant posterior elbow swelling and tenderness to palpation over the distal triceps tendon, olecranon, and lateral epicondyle. Passive and active range of motion and motor testing of the shoulder, elbow, and wrist were limited due to pain. MRI of the right elbow was ordered given the severity of symptoms and demonstrated a complete tear of the triceps tendon at the olecranon insertion with 5.3 cm of retraction.

Discussion (relevance): Injuries following a FOOSH are typically located in the hand, wrist, and forearm structures. This case demonstrates the less common occurrence of a complete triceps tear following a FOOSH. The underlying mechanism of this injury is an abrupt, forceful eccentric contraction of the triceps brachii. Pain and swelling following polytrauma can be understandably overlooked when initial imaging is negative for fractures or dislocations. As demonstrated in this case, a major diagnosis was missed and appropriate referral was delayed.

Conclusions: Thorough examination, consideration of involved structures and injury mechanism are important to properly diagnose and treat atypical pathology in common injuries. Triceps brachii tears are an uncommon injury from a FOOSH but should be considered in patients with persistent and severe elbow pain/swelling with unremarkable x-rays.