Triceps tendon tear-MRI

Young adult with history of athletic trauma  shows on MRI classical appearance of combined tendon of lateral and long heads  complete  tear  with retraction of the tendon, with intact medial head  component , with large fluid collection post to olecranon possibly hematoma or bursa (as the history is of 3 months)

Teaching points by DR MGK Murthy

1.Triceps (major extensor of elbow)  is tripennate muscles 

(a) infra glenoid tubercle of scapula (long head) 

(b) upper post humerus (lateral head) 

(c ) Lower posterior humerus (medial head) with distal insertion on to olecranon and  a lateral aponeurotic component merging with anconeus to the proximal forearm fascia 

2.Football linesmen, weightlifters, athletes with repetitive loading  during elbow  extension are candidates  with  most  clinical cases being among the non athletes (falls on outstretched hand or lifting injuries or blunt trauma )

3. Anterior medial head component  usually remains intact  including its  separate anterior insertion on to olecranon 

4.Clinical diagnosis difficult because of  hematoma , limited movements  etc

5. Xray is pathognomonic  if shows avulsed fracture fragment  of post olecranon

6.MRI shows tear,  hematoma, components separately, retraction, grade of injury .Complete tears more common. posterior component (combined long and lateral heads tendon) is usually involved 

7.False negatives may be when retracted tendon is too high to be seen in routine elbow scans and repeat imaging higher up may be needed. Intact anterior component may give an impression of intact tendon

8.primary repair possible within 3 weeks . others will need   complex reconstruction with surgery a must for most cases . 

9. Previous literature (till Dr Madsen described) was possibly erroneously referring to intact  anterior component  as incomplete tears (which are actually complete tars of combined tendon)