Biceps and triceps tendon tears at the elbow are not common injuries, but they can be painful and can limit daily activities if not addressed promptly. Let’s take a look at how each injury occurs and how they are treated.
Biceps tendon tears
Most biceps tendon tears at the elbow occur in middle-aged males who are active. The injury typically occurs when the elbow is flexed and something lands on the hand or forearm to forcibly extend the elbow, which can happen in many scenarios, including when working on a car or when lifting and moving furniture, appliances, or other heavy objects. While spontaneous rupture of the biceps tendon is possible, it’s extremely rare and typically tied to the use of certain medications that increase the risk of tendon rupture.
In most cases, surgery is required to treat a biceps tendon tear. While there are other flexors that can compensate and still flex the elbow pretty normally, patients with distal biceps rupture lose supination strength in their arm, which is the motion required for turning a screwdriver, opening a door, or opening a jar. Since this injury most often occurs in active men, surgery is usually indicated to repair the tear and restore that strength. For low-demand individuals or those with significant medical conditions precluding safe anesthesia, non-operative treatment is preferred.
If surgery occurs within a few weeks of the injury, it’s a fairly simple procedure that involves making a small incision and using a button to reattach the tendon to the bone. The patient is generally in a splint for a week or two to allow the incisions to heal, then physical therapy will begin. Initially, the elbow will be very tight, and it takes a lot of therapy to help stretch it out and regain full motion before moving on to strengthening.
Prompt treatment is necessary for this injury, as the tendon can begin to retract, or pull up the arm toward the shoulder, as time passes. When a tendon retracts further up in the arm, a larger incision may be necessary to release some adhesions or do a tendon graft to reattach it to the bone.
Triceps tendon tears
The triceps muscle acts as an extender of the elbow, and rupture to the triceps tendon at the elbow is even less common than a biceps tendon tear. Nearly all cases of a triceps tendon tear require surgery, as there are no other muscles which do a good job of substituting for this function.
While a partial tear is possible and can be treated non-operatively, most triceps tendon tears are a complete rupture. The injury occurs when the elbow is extended and some sort of flexion force is applied, which can occur with weight lifting, moving heavy objects, or other accidents. There’s also an association between use of anabolic steroids and risk of this specific injury.
The triceps tendon attaches to the olecranon, the bone that forms the tip of the elbow. Surgical repair generally doesn’t involve any hardware, and the tendon is repaired through drill holes in the bone. The sutures are constructed from the same material that bulletproof vests and helmets are made of, so they are very strong.
Following surgery, patients will generally wear a splint for a week or two in relaxed extension so there’s no tension on the repaired tendon. Then they will start physical therapy to restore motion and eventually strengthen the area.
For either biceps or triceps repair, patient factors such as uncontrolled diabetes or smoking can increase infection risk. For the best surgical outcomes, stop smoking and ensure your blood sugar is well controlled before undergoing surgery.