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      Triceps Tendon Avulsion: A Rare Injury

      case-report

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          Abstract

          Background

          Triceps tendon avulsion is one of the rare tendinous injuries. Such injuries can easily be missed, and should be kept as a differential diagnosis in all patients who present with pain and swelling at the back of the elbow after a traumatic event.

          Case Details

          We present a case of triceps tendon avulsion which was missed in the initial workup by a local practitioner. Careful physical examination and evaluation of the X-rays clinched the diagnosis. The patient was treated surgically by transosseous suture technique using the Krakow method. The end result was a good range of movement and a power equal to the uninjured side. A high index of suspicion, physical examination seeking a palpable gap, and search for a ‘flake’ fracture on lateral radiographs will help make the diagnosis of triceps avulsion. Early recognition of these injuries and prompt intervention are the cornerstones of a successful outcome. A second examination after a few days, when the swelling has reduced, should be the standard in doubtful cases or during any unclear joint injury. We recommend a primary repair through a transosseous suture technique using Krakow method for optimal results.

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          Most cited references15

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          Disruption of muscles and tendons; an analysis of 1, 014 cases.

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            Surgical treatment of distal triceps ruptures.

            Distal triceps tendon ruptures occur rarely, and the diagnosis is often missed when the injury is acute. The literature provides little guidance regarding treatment or the outcome of treatment of these injuries. The goal of this report was to present our experience with the diagnosis, timing and technique of surgical treatment, and outcome of treatment of distal triceps tendon ruptures in twenty-two patients. None of the ruptures followed joint replacement. Twenty-three procedures were performed in twenty-two patients with an average age of forty-seven years. The average duration of follow-up was ninety-three months (range, seven to 264 months). Data were obtained by a retrospective review of records and radiographs before and after surgery. Also, thirteen patients returned for follow-up and were examined clinically. Six additional patients responded to a telephone questionnaire. One patient was lost to follow-up, and two had died. Formal biomechanical evaluation of isokinetic strength and isokinetic work was performed in eight patients, at an average of eighty-eight months after surgery. Isokinetic strength data were available from the charts of two additional patients. Ten of the triceps tendon ruptures were initially misdiagnosed. At the time of diagnosis, triceps weakness with a decreased active range of motion was found in most patients, and a palpable defect in the tendon was noted after sixteen ruptures. Operative findings revealed a complete tendon rupture in eight cases and partial injuries in fifteen. Fourteen primary repairs and nine reconstructions of various types were performed. Three of the primary repairs were followed by rerupture. At the time of follow-up, the range of elbow motion averaged 10 degrees to 136 degrees. All but two elbows had a functional range of motion; however, the lack of a functional range in the two elbows was probably due to posttraumatic arthritis and not to the triceps tendon rupture. Triceps strength was noted to be 4/5 or 5/5 on manual testing in all examined subjects. Isokinetic testing of ten patients showed that peak strength was, on the average, 82% of that of the untreated extremity. Testing showed the average endurance of the involved extremity to be 99% of that of the uninvolved arm. The results after repair and reconstruction were comparable, but the patients' recovery was slower after reconstruction. The diagnosis of distal triceps tendon rupture is often missed when the injury is acute because of swelling and pain. Primary repair of the ruptured tendon is always possible when it is performed within three weeks after the injury. When the diagnosis is in doubt immediately after an injury, the patient should be followed closely and should be reexamined after the swelling and pain have diminished so that treatment can be instituted before the end of this three-week period. Reconstruction of the tendon is a much more complex, challenging procedure, and the postoperative recovery is slower. Thus, we believe that early surgical repair, within three weeks after the injury, is the treatment of choice for distal triceps tendon ruptures. of evidence.
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              Triceps tendon ruptures in professional football players.

              Distal rupture of the triceps tendon is a rare injury, and treatment guidelines are not well established. Football players with triceps tendon ruptures will be able to return to their sport with minimal functional deficits. Uncontrolled retrospective review. Twenty-one partial and complete ruptures of the triceps tendon were identified in 19 National Football League players over a period of 6 years. Team physicians retrospectively reviewed training room, clinical, and operative notes for each of these players. Most of the injured players were linemen. The most common mechanism of injury was an eccentric load to a contracting triceps. Seven players had prodromal symptoms prior to injury, and 5 had received a cortisone injection. Eleven elbows with complete tears underwent surgical repair. Of 10 players with partial tears, 6 healed without surgery. One player suffered a subsequent complete tear requiring surgery, and 3 with residual pain and weakness underwent surgical repair following the season. Two surgical complications occurred, both requiring a second operation. All of the players but 1 returned to play at least one season of professional football after their injury. Partial triceps tendon ruptures can heal without functional deficit. Surgical repair for complete ruptures generally produces good functional results and allows return to play.
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                Author and article information

                Journal
                Ethiop J Health Sci
                Ethiop J Health Sci
                Ethiopian Journal of Health Sciences
                Research and Publications Office of Jimma University (Jimma, Ethiopia )
                1029-1857
                January 2014
                : 24
                : 1
                : 97-99
                Affiliations
                [1 ] Department of Orthopaedics & Traumatology, Gandhi Medical College & Hamidia Hospital, India
                Author notes
                Corresponding Author: Dr. Pulak Sharma, drpulaksharma@ 123456gmail.com
                Article
                jEJHS.v24.i1.pg97
                10.4314/ejhs.v24i1.14
                3929935
                24591806
                c3179614-f324-41ba-9559-e420814ba8d9
                Copyright © Jimma University, Research & Publications Office 2014
                History
                Categories
                Case Report

                Medicine
                krakow,triceps avulsion,ethibond
                Medicine
                krakow, triceps avulsion, ethibond

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