Distal Triceps Injuries

A distal triceps injury occurs when the tendon is overstretched, strained, or torn, often due to excessive force. The severity of the injury can range from minor inflammation (tendinitis) to a partial tear (where some tendon fibers are damaged) or a complete rupture (where the tendon detaches from the bone). A complete tear can make it nearly impossible to straighten the elbow without assistance.

Triceps tendon injuries are considered rare compared to other tendon injuries, but when they occur, they can be debilitating. If left untreated, a full-thickness tear can lead to chronic weakness, pain, and impaired arm function. Acute triceps ruptures occur mainly in athletes, weight lifters (especially if they take anabolic steroids), and after elbow trauma.

Distal triceps injuries typically result from sudden forceful movements or repetitive overuse. Several factors can contribute to these injuries, including:

• Trauma or direct impact – A fall onto an outstretched hand or a direct blow to the back of the elbow can overstretch or tear the tendon.
• Excessive force during pushing or lifting – Heavyweight lifting, particularly bench presses or overhead presses, can place extreme stress on the triceps tendon, leading to injury.
• Eccentric loading – This occurs when the triceps muscle is forced to contract while lengthening, such as when controlling a heavy weight downward or absorbing force during impact.
• Overuse and repetitive strain – Athletes or individuals engaged in activities involving frequent pushing motions, such as football players, boxers, weightlifters, and construction workers, are at higher risk of developing tendon damage over time.
• Tendon degeneration – Aging, chronic inflammation, or conditions such as tendinitis can weaken the triceps tendon, making it more vulnerable to tears.
• Medical conditions and medications – Systemic diseases like rheumatoid arthritis, diabetes, and chronic kidney disease can increase the risk of tendon injuries. Additionally, long-term corticosteroid use, and anabolic steroids can weaken tendons and contribute to ruptures.

Symptoms of a distal triceps injury depend on the severity of the tendon damage. Individuals with this injury may experience:

• Pain – Discomfort or sharp pain at the back of the elbow, especially when extending the arm
• Swelling and bruising – Inflammation may develop quickly, and bruising can spread down the arm
• Weakness in arm extension – Difficulty straightening the elbow or pushing objects away from the body
• Tenderness over the triceps tendon – Pain when pressing on the area just above the elbow
• A visible defect or gap – A noticeable depression above the elbow where the tendon has pulled away (in the case of a complete rupture)
• A popping or tearing sensation – A sudden feeling of something giving way at the back of the elbow at the time of injury
• Loss of strength – Reduced ability to perform everyday tasks that involve arm extension, such as pushing open a door or performing push-ups

Proper diagnosis is essential to determine the extent of the injury and develop an appropriate treatment plan. Dr. David Gazzaniga, a leading orthopedic surgeon and sports medicine specialist at Newport Orthopedic Institute, uses a comprehensive approach to evaluate distal triceps injuries. This process includes:

• Medical history and physical examination – Dr. Gazzaniga will ask about the injury event, symptoms, and any history of previous elbow issues. During the exam, he will assess pain levels, tenderness, swelling, and arm strength. He will also use special tests to evaluate the function of this tendon.
• X-rays – While X-rays do not show soft tissue injuries directly, they can help identify avulsion fractures, where a small piece of bone is pulled off along with the tendon.
• Ultrasound – A real-time imaging technique that allows Dr. Gazzaniga to examine the integrity of the tendon and detect partial or complete tears.
• Magnetic Resonance Imaging (MRI) – The gold standard for diagnosing tendon injuries, an MRI provides a detailed view of the soft tissues, helping to confirm whether the tendon is partially or fully torn and whether any surrounding structures are affected.