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)
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