The Centers for Advanced Orthopaedics
Maryland Orthopedic Specialists
A Division of The Centers for Advanced Orthopaedics
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Elbow

Triceps Tendon Rupture

Triceps tendon rupture is the rarest of all major tendon ruptures in the body, accounting for fewer than 1% of tendon injuries. Despite its rarity, prompt diagnosis is critical. Missed or delayed diagnosis leads to progressive extensor weakness and elbow dysfunction. At Maryland Orthopedic Specialists, we have the surgical expertise to repair these injuries and restore full elbow extension strength.

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What is triceps tendon rupture?

The triceps brachii is the sole extensor of the elbow. Its distal tendon inserts on the posterior surface of the olecranon process of the ulna. Rupture occurs at or near this osseous insertion and results in partial or complete loss of active elbow extension.

The triceps brachii is the sole extensor of the elbow. Its distal tendon inserts on the posterior surface of the olecranon process of the ulna. Rupture occurs at or near this osseous insertion and results in partial or complete loss of active elbow extension.

Mechanism: The classic injury is an eccentric load applied to an actively contracting triceps, most commonly during:

  • Weightlifting (failed triceps press, bench press with eccentric overload)
  • A fall on an outstretched hand with reflex triceps contraction
  • Direct posterior elbow trauma

Risk factors include:

  • Anabolic steroid use is strongly associated; steroids impair collagen synthesis and disrupt tendon microarchitecture, leading to degeneration.
  • Systemic corticosteroid use
  • Renal osteodystrophy and secondary hyperparathyroidism
  • Olecranon bursitis with local steroid injection
  • Fluoroquinolone antibiotic use (associated with tendinopathy broadly)

Epidemiology: Predominantly affects men aged 30–50 years. Partial tears are more common than complete ruptures.

Symptoms — do you recognize these?

  • Sudden posterior elbow pain with an audible or perceived "pop"
  • Immediate weakness of elbow extension
  • Swelling and ecchymosis over the posterior elbow
  • Palpable defect in the triceps tendon approximately 1–2 cm proximal to the olecranon
  • Inability to extend the elbow against gravity (complete rupture)
  • Preserved but weak extension (partial tear)

Call us at (301) 515-0900. Same-day appointments available at our Bethesda and Germantown locations.

How we diagnose it

Physical examination:

  • Modified Thompson test (triceps squeeze test): Analogous to the Thompson test for Achilles rupture. With the patient prone and the elbow hanging off the table at 90°, squeezing the triceps muscle belly should produce passive elbow extension if the tendon is intact. Failure to extend indicates complete rupture.
  • Palpation for a tendon defect proximal to the olecranon.
  • Active extension testing against gravity.

Imaging:

  • Plain radiographs: May reveal an avulsion fragment at the olecranon tip (a "flake sign" on the lateral view is pathognomonic for triceps avulsion).
  • Ultrasound: Cost-effective, dynamic real-time assessment; identifies complete vs. partial tear and degree of retraction.
  • MRI: Gold standard; confirms diagnosis, characterizes partial vs. complete tear, and guides surgical planning.

Treatment options

Non-operative

Non-operative management: Appropriate only for minor partial tears (<25–50% thickness) in low-demand patients. Risk of progression to complete rupture with continued activity.

Surgical Repair

Surgical repair: Recommended for complete ruptures in any patient, and partial tears (>50% of tendon width) in active patients. Technique: The tendon stump is reattached to the olecranon using transosseous sutures, suture anchors, or a combination. Early surgical repair (within 2–4 weeks) is preferred. Late repairs are technically more difficult and may require augmentation with fascia lata, semitendinosus allograft, or anconeus muscle rotation flap. Outcomes: Surgical repair produces excellent return of elbow extension strength and low re-rupture rates. Most patients return to prior functional level within 4–6 months.

Recovery & rehabilitation

  • Splinting at 30° of flexion for 2–3 weeks post-operatively.
  • Progressive ROM exercises from week 3; full passive extension achieved by week 6.
  • Strengthening begins at 6–8 weeks.
  • Return to weightlifting and heavy manual work at 4–6 months.
  • Triceps-specific loading (pressing, dips) restricted until 4–5 months.

Frequently Asked Questions

Why is triceps rupture so rare?
The triceps is a comparatively less powerful muscle than the quadriceps or gastrocnemius-soleus complex, and its loads during normal activity are lower. However, the eccentric forces encountered in weightlifting or a fall can exceed tendon tolerance, particularly in tendons already weakened by steroid use or systemic disease.
Do anabolic steroids cause tendon tears?
Yes. Anabolic steroids promote rapid muscle hypertrophy that outpaces tendon adaptation, and they directly impair collagen synthesis, predisposing tendons to rupture at lower loads. Triceps rupture in a young weightlifter should prompt discussion of steroid use.
Will I be able to do push-ups and bench press again?
Most active patients return to full upper extremity athletic activities, including weightlifting, within 4–6 months of surgical repair.
How is a triceps tendon rupture diagnosed?
Diagnosis begins with a physical examination. A complete triceps rupture typically causes a visible or palpable defect just above the elbow, significant weakness with elbow extension, and inability to extend the arm against resistance. The "modified Thompson test" (squeezing the back of the upper arm and checking for elbow extension) can help confirm the diagnosis at bedside. An MRI is the most accurate imaging study and can characterize whether the tear is partial or complete, how far the tendon has retracted, and whether the bone (olecranon) has been avulsed. At MOS, your surgeon will combine clinical findings with MRI to plan the most appropriate repair.
How long after surgery will it take to regain full strength?
After surgical repair of a triceps tendon rupture, the elbow is protected in a splint at a comfortable angle for 2–4 weeks, followed by gradual range-of-motion exercises. Strengthening exercises begin at approximately 6–8 weeks, with progressive loading guided by pain and surgeon assessment. Most patients regain functional strength for daily activities by 3–4 months, but return to heavy lifting, bench press, or overhead sports typically takes 6–9 months. Final strength recovery can continue for up to 12 months, and your MOS surgeon will work with you and a physical therapist to ensure a safe and complete return to your pre-injury activities.

Meet the specialists

Peter G. Fitzgibbons, MD

Peter G. Fitzgibbons, MD

Hand Surgery · Orthopedic Surgery

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Related conditions

Distal Biceps Tendon RuptureElbow Fractures
Medically reviewed by Peter G. Fitzgibbons, MD
Last reviewed June 15, 2026

References

  1. Van Riet RP, Morrey BF, Ho E, O'Driscoll SW. Surgical treatment of distal triceps ruptures. Journal of Bone and Joint Surgery (JBJS). 2003;85(10):1961–1967. https://doi.org/10.2106/00004623-200310000-00015
  2. Rineer CA, Guitton TG, Ring D. Radial head fractures: loss of cortical contact is associated with concomitant fracture or dislocation. Journal of Shoulder and Elbow Surgery (JSES). 2010;19(1):21–25. https://doi.org/10.1016/j.jse.2009.05.002
  3. American Academy of Orthopaedic Surgeons. Triceps Tendon Tears. OrthoInfo. https://orthoinfo.aaos.org/en/diseases--conditions/triceps-tendinitis (accessed May 2026).
  4. Anzel SH, Covey KW, Weiner AD, Lipscomb PR. Disruption of muscles and tendons: an analysis of 1,014 cases. Surgery. 1959;45(3):406–414. PMID: 13637689. https://pubmed.ncbi.nlm.nih.gov/13637689
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