Distal Triceps Tendon Ruptures

The triceps muscle on the back of your upper arm attaches to the bony point at the tip of your elbow (the olecranon) through the distal triceps tendon, and that tendon is what lets you straighten the arm. A distal triceps tendon rupture is the least common of the upper-limb tendon ruptures, but when it happens it takes that motion away: with a complete tear, you has weakness straightening the elbow against resistance, though some patients keep weak extension.

The tendon usually tears from a fall onto an outstretched arm, or from a sudden load while pushing off (think a bench press or push-up gone wrong, where the elbow is forced to bend while the triceps is firing hard to keep it straight). A handful of factors weaken the tendon and make a tear more likely: anabolic steroid use, repeated corticosteroid injections near the tendon, kidney failure, and hyperparathyroidism.

You will feel a sudden sharp pain at the back of your elbow during a forceful push or after a fall, sometimes with a pop. Swelling and bruising develop quickly over the back of the elbow, and you may notice a soft gap just above the bony point (the olecranon) where the tendon should be.

The defining symptom is weakness or inability to straighten your elbow against gravity: pushing yourself up from a chair or doing a push-up becomes impossible. With a partial tear, you may still extend the elbow but with noticeably less power and a sense that something is wrong at the back of the joint.

Your provider examines the elbow for the pain, swelling, and weakness that follow the injury, and checks whether you can straighten the elbow against resistance. In a complete tear your surgeon can often feel a soft gap right above the bony tip of the elbow. X-rays sometimes show a tiny chip of bone pulled off where the tendon attached (the flake sign). MRI confirms the diagnosis and shows how much of the tendon is torn.

Whether a tear can be managed without surgery comes down to how much of the tendon is torn. A partial tear, where you can still straighten the arm, can often be treated by protecting the elbow while the tendon heals and then rebuilding motion and strength. A complete tear is a different situation, covered in the next section. The steps below are the non-surgical plan for a partial tear, introduced in order.

1. Bracing & Protected Positioning

   For partial tears where you can still straighten the arm, the elbow is supported in a brace during the early healing phase. The brace takes the pull off the healing tendon so it is not loaded before it is ready.

2. Progressive Return to Motion

   Once the early healing phase is past, motion and strength are advanced gradually under guidance, so the tendon is reloaded a step at a time rather than all at once.

Complete tears, where you cannot straighten your elbow, should be repaired promptly. The longer you wait, the more the tendon retracts up the arm and scars to the surrounding tissue, which makes the eventual repair harder and the result less reliable.

If the tendon is fully torn, this procedure can address this condition:

• Distal triceps repairElbow

External patient-education references and related OSI pages for additional background:

• AAOS OrthoInfo, patient education library
• OSI glossary, orthopedic terminology in plain language