Triceps Tendon Tears — A Rare But Serious Injury

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This season, we saw Offensive Lineman Damien Cook of the Detroit Lions suffer a season-ending injury on the first day of practice. It was discovered that he had sustained a tear in his triceps muscle, a potentially career-threatening injury which required prompt surgical repair and significant rehabilitation to provide him a viable chance at return to play. Unfortunately, Damien is not alone, as triceps tendon injuries have had a serious impact on many athlete’s careers.
The triceps is the powerful muscle on the back of the upper arm that is responsible for straightening the elbow. It attaches to the shoulder blade on one end and to the elbow on the other. It is an important muscle in both everyday activities as well as in athletics. A triceps rupture specifically refers to the tearing of the tendon that attaches the powerful triceps muscle along the back of the arm to the tip of the elbow. Triceps ruptures commonly occur with falls onto an outstretched hand or during a block in football, when a sudden force causes the elbow to bend while the triceps muscle is simultaneously contracting and trying to straighten the elbow. The athlete’s body weight is resisted by the triceps contraction, however the force may be too much and the tendon ruptures.
While triceps ruptures are relatively common, they are devastating injuries for athletes when they are missed and go untreated. For this reason, the doctor and athletic trainer must maintain a low index of suspicion. An injured athlete will describe a mechanism of injury where the elbow was forcibly bent while he or she was trying to extend it. There will be tenderness to the touch and swelling where the tendon attaches to the back of the elbow. There will also be weakness when the elbow is extended against resistance. An ultrasound or MRI can be very useful to confirm the diagnosis and specifically identify the location of the tear and degree of retraction of the tendon.

Complete ruptures of the triceps tendon typically require surgery in athletes who wish to return to play at the prior level of competition. An incision is necessary on the back of the elbow to reattach the tendon directly to bone. If this injury is missed or neglected, the athlete will have significant weakness with elbow extension and may not be able to maintain a block in football or rugby, lift weights, or perform push-ups. It is critical to promptly seek the counsel of your local sports medicine specialist if you suspect that you have sustained a triceps tendon injury. We wish Damien Cook an expeditious recovery and look forward to seeing him in action on the football field.

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