Distal Triceps Tendon Rupture
A distal triceps tendon rupture is an uncommon injury in which the tendon that straightens the elbow tears from the olecranon.
How the injury occurs
The triceps tendon attaches the triceps muscle to the olecranon at the back of the elbow. It is the primary tendon responsible for active elbow extension. Rupture can follow a fall, direct trauma, weightlifting, contact sports, or sudden eccentric load. Risk factors can include chronic kidney disease, anabolic steroid exposure, local corticosteroid injection, systemic disease, and preexisting tendon degeneration, although many patients have no identifiable risk factor.
Symptoms and diagnosis
Typical symptoms include a pop, posterior elbow pain, bruising, swelling, weakness pushing away from the body, difficulty rising from a chair using the arms, and a gap near the olecranon. A patient with a partial tear may retain extension but have pain and reduced strength. X-rays evaluate avulsion fragments and associated fracture. Ultrasound or MRI can define the percentage of tendon involvement, retraction, and tissue quality. The examination also assesses the ulnar nerve and the ability to extend the elbow against gravity and resistance.
Treatment options
Selected partial tears may be treated with temporary immobilization, activity modification, and progressive rehabilitation when extension strength remains adequate. The decision depends on tear size, symptoms, weakness, activity demands, and tendon quality. Complete tears and high-grade partial tears in active patients are commonly repaired surgically. The tendon is reattached to the olecranon with sutures secured through bone tunnels, anchors, or another fixation construct. Chronic tears may require a more extensive release or graft augmentation.
Recovery
After repair, the elbow is protected while the tendon heals. Motion is introduced in a controlled progression, often with a brace, followed by strengthening. Heavy pushing, pressing, weight training, and contact sports return later than desk work and light daily activity. Published rehabilitation protocols vary, so progression is individualized according to repair quality, tissue condition, healing, and functional demands.
Risks and expectations
Potential risks include infection, stiffness, ulnar nerve symptoms, heterotopic bone formation, persistent weakness, rerupture, hardware irritation, and additional surgery. Most repaired patients regain useful extension strength, but return to maximal pushing or high-level athletics depends on the original injury, tissue quality, and rehabilitation.
This information is educational and is not a substitute for an individualized medical evaluation. Written and medically reviewed by Michael L. Knudsen, MD | Last reviewed: July 2026
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