Triceps tendon repair

The triceps muscle is found at the back of the upper arm and its primarily function is to extend the elbow. The muscle consists three distinct heads – the long head, the lateral head and the medial head. While these three heads attach at different points around the upper arm and scapula, all three converge together and insert distally at the elbow to the olecranon process of the ulnar via the triceps tendon. It is this distal tendon that is very important for elbow function, and when ruptured, would usually warrant surgical repair. 

Kemble's repair technique involves reattachment of the tendon securely to the bone using high strength sutures passed through bony tunnels and reinforced with buried anchors. 

Anatomy of the triceps muscle and tendon (left). Surgical repair of triceps tendon rupture at the elbow (right).

Post-operative rehabilitation (developed in conjunction with Melbourne Hand Therapy)

It is vital that the triceps tendon be protected after surgery and during the healing phase. Post-operatively, the elbow will be immobilised for the first two weeks with a back-slab applied.  There will be an incision on the back of the elbow with sutures holding it closed and it will be kept dry with a water-resistant dressing. To ensure a full recovery, all bandages and dressings must remain intact and dry until the first post-operative appointment with Kemble. During this time, a plastic bag tied above the elbow can be used to prevent the arm from getting wet during showering or, alternatively, a one-handed bath can be taken. Kemble will review the wound and advise as to when it is safe and practicable to get it wet.

Two weeks post surgery:

  • Finger, wrist and gentle assisted/supported shoulder movements will commence as soon as possible to maintain movement and avoid stiffness;

  • The arm should remain as elevated as much as possible, particularly in the first 5-7 days, to reduce the risk of swelling.

Weeks 2-6 post surgery:

  • The post-operative back-slab and primary dressing of the wound will be removed;

  • Tubigrip (or similar) will be applied to the elbow to reduce post-operative swelling;

  • Scar management will commence;

  • Active elbow flexion and passive elbow extension exercises will begin. These exercises are undertaken in a seated position with the arm supported on a table and the shoulder stable at 70-90 degrees. No active triceps extension or passive elbow flexion will occur until the 6 weeks post-operative appointment;

  • Hand, wrist, and shoulder exercises are to continue;

  • The sling should continue to be used when not performing exercises;

  • It is still too early for any functional use of the arm.

 

Weeks 6-12 post surgery:

  • All active and passive range of motion exercises to prevent stiffness/contracture will begin;

  • Sling no longer needs to be used;

  • Light functional use of the arm can commence however no weight bearing through the arm or eccentric contraction of the triceps muscle should occur.

Weeks 12+

  • Strengthening and conditioning exercises of the elbow and shoulder should continue;

  • Weightbearing conditioning exercises will commence

  • Work should continue if necessary, to correct any range of motion deficits.

Return to activity

  • Because eccentric contraction and loading of the triceps must be avoided until 12 weeks post-surgery, functional loading and sports must be avoiding throughout this phase.

  • At this stage, a therapist will direct and guide a continued strengthening program and help determine a return to sport and/or loading activities schedule which will be based on individual recovery needs)

General post-operative things to be aware of:

  • Some tingling, numbness or weakness following the procedure is normal. This is often a result of the nerve block performed before surgery to help manage pain, or the local anaesthesia injected postoperatively. The effects will wear off in the first day or two.

  • If drainage from the wound continues after two week, contact Kemble

  • If sudden snapping sensation in the back of the elbow is experienced, please contact Kemble, as this may indicate rupture of repair.

Possible Complications

  • Ulnar nerve irritation or injury;

  • Elbow joint stiffness/Triceps contracture;

  • Re-rupture of tendon.

©2020 Kemble Wang Orthopaedics

 

Disclaimer: All information provided on this webpage should be considered as general guidelines. Actual practice and (expected) outcomes may differ in your case. The contents has been created online for information purposes only. It is not intended to be a substitute for specific advice from either Kemble Wang or your other healthcare practitioners