pathology: triceps tendon injuries (rupture, insertional tendopathy)

yogabook / pathology / triceps tendon injuries

Injuries to the triceps tendon are relatively rare, around half are caused by trauma, a further 20% result from weight training, mostly from bench presses, dips or forehead presses, which can also lead to rupture of the tendon. Predisposing factors are local cortisone infiltrations, bursitis olecrani, systemic diseases and some sports such as football. Ruptures often occur on the basis of existing tendopathies with or without bone spurs. The triceps–insertion consists of a profound layer formed by caput mediale and a superficial layer formed by caput laterale and caput longum. The olecranon has a hypomochleon function, just 2 cm less length reduces the force by 40%. Distal injuries to the tendon of the triceps account for less than one per cent of all tendon disorders of the upper extremity. Ruptures more frequently affect the superficial leaflet, and there mainly caput longum. The enthesis is affected much more frequently than the myotendinous junction. An anamnestic question must be asked about a noise typical of a tear. As both blades contain a monoarticular head, the tendon does not retract, which can lead to tears being overlooked. The extension of the elbow joint against resistance is painful and the development of strength is limited due to pain; in addition to swelling, a haematoma may also occur.
If a gap in the tendon contour is palpable, this indicates a tear, whereby tears in the lower leaf can be covered by the upper leaf. Older tears can lead to asymmetry in the shape of the triceps in lateral comparison. Attention must be paid to an avulsion in the X-ray. Larger ruptures are difficult to treat conservatively, as they often lead to a loss of strength of up to 50%. Muscle fibre tears or tears in the myotendinous junction are worth trying conservative treatment, with different approaches depending on the strain at work and in sport. If surgery is necessary, this is best done within the first two weeks. The results are good in over 90% of cases, but slight strength deficits may remain in strength athletes in short sarcomere lengths. Delayed ruptures show slightly worsened results and strength deficits of up to almost 20%. The restoration of the original length of the tendon is relevant for maximum strength. Full resilience and strength is only achieved after up to a year .

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Definition of

Cause

  1. Overuse in weight training (bench press, dips or forehead presses), especially repetitions performed with momentum
  2. Sudden, violent flexion of the elbow joint with tense triceps

Predisposing

  1. Tendon-damaging drugs such as fluoroquinolones
  2. Underlying diseases with a tendency to tendon disorders such as CED
  3. Localised cortisone infiltrations
  4. Bursitis olecrani

diagnosis

  1. Palpation
  2. Sono
  3. MRI

Symptoms

  1. Painful extension of the elbow joint against resistance
  2. In the case of ruptures, possibly asymmetry in lateral comparison, strength deficit

Complications

  1. With insertion tendopathy: rupture
  2. For ruptures: residual strength deficit

Therapy

  1. Discontinuation of the triggering activities
  2. HSR strengthening training
  3. if necessary: OP