Acute Bilateral Elbow Pain After A Fall - Page #4

Working Diagnosis:
Bilateral High Grade Triceps Tendon Partial Ruptures

Initial treatment consisted of relative rest, including avoidance of elbow extension against resistance, ice, compression, elevation, and NSAIDs for pain control. The orthopedic surgeon recommended primary repair of the right triceps tendon, followed later by repair of the left triceps tendon in the future if still symptomatic. The patient was reluctant to undergo surgery and requested a second opinion. He was subsequently lost to follow-up for this issue. When he was seen subsequently for an unrelated issue, he said that he didn’t keep the appointment for his second opinion and didn’t follow up with the initial surgeon either.

The patient did well with conservative treatment, with the pain and swelling resolving over several weeks. He was able to return to work and perform all ADL’s without any limitations, and subsequently was able to resume weightlifting as well. However, he continued to avoid heavy weights with elbow extension.

Author's Comments:
Triceps tendon ruptures are relatively rare in relation to other tendon injuries. This is a case of simultaneous bilateral high grade triceps tendon ruptures.

Editor's Comments:
Illustrates clinical presentation of a rare triceps injury.
Presents conservative options to consider as alternative to surgery for triceps tendon ruptures. It appears that in this case the patient proved that nonsurgical treatment is reasonable even when surgical treatment is recommended.

Bradley, J., F. Tjoumakaris, and L. Austin. “Distal Biceps and Triceps Tendon Ruptures” in De Lee and Drez’s Orthopaedic Sports Medicine, 4th edition, edited by M. Miller and S. Thompson. Philadelphia, PA: Saunders, 2015. 761-770.

Tom, J., N. Kumar, D. Cerynik, R. Mashru, and M. Parella. “Diagnosis and Treatment of Triceps Tendon Injuries: A Review of the Literature.” Clinical Journal of Sports Medicine volume 24 (2014): 197-204.

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