Anatomy
The elbow joint is the joint connection between the humerus and the two bones of the forearm: the radius and the ulna. The elbow’s large extensor muscle (triceps) is located on the back of the upper arm. The triceps muscle has three muscle heads: one internal (caput mediale), one external (caput laterale) and one long (caput longus). The first two muscle heads originate from the back of the humerus, but the long muscle head originates from the scapula (tuberculum infraglenoidale). The three muscle heads attach together at the tip of the ulna (olecranon ulna).
Shoulder and upper arms muscles from behind:
A. Clavicula (Collarbone)
B. Bursa subcutanea acromialis
C. M. deltoideus
D. M. triceps brachii (caput laterale)
E. M. brachioradialis
F. Epicondylus lateralis
G. Olecranon (Tip of the elbow)
H. Epicondylus medialis
I. M. triceps brachii (caput mediale)
J. M. triceps brachii (caput longum)
Cause
When a muscle is suddenly subjected to a load that exceeds the muscle’s strength, a rupture occurs, often accompanied by a haemorrhage. In some cases, the muscle tear (contusion) and haemorrhage occur after a direct blow to the muscle. The vast majority of tears are partial muscle tears. Tears most often occur if the muscle contracts while being stretched (eccentric contraction).
Injuries in muscles can be localised in the muscle tissue itself, in the fascia around/between the muscles or in the tendon part of the muscles, which has a major impact on prognosis (muscles heal much faster than tendons).
Total tears are very rare and are usually localised at the attachment at the tip of the ulna (olecranon ulna). When the muscle ruptures, especially if it is injured after a direct blow to the muscle, bleeding can occur in the muscle. In some cases, there may be calcifications corresponding to the bleeding (myositis ossificans) or fluid may be drawn into the bleeding, causing a fluid collection in the muscle (hygroma)complications of muscle haemorrhage.
Symptoms
In mild cases, a localised soreness is felt after the strain (‘muscle strain’, ‘threatening fibre’). In more severe cases, a sudden shooting pain is felt in the muscle (‘partial muscle rupture’, ‘fibre rupture’) and in the worst case, a violent pop is felt, after which elbow extension against resistance has ceased (‘total muscle rupture’, which is very rare).
In muscle injuries, the following three symptoms are characteristic: Pain on pressure, stretching (bending at the elbow joint) and activation against resistance (stretching at the elbow joint). If there is major bleeding or fluid accumulation in the muscle, you will often feel a firm filling in the muscle.
Examination
The diagnosis is usually made during a clinical examination. Symptoms can be provoked by pressure on the triceps muscle and by trying to extend the elbow against resistance. For more severe pain or difficulty using the arm, an examination by an appropriate professional should be performed to ensure proper diagnosis and treatment.
This may need to be supplemented with an ultrasound scan, where even minor irregularities in the muscle fibres, bleeding and calcifications can be seen (possibly an MRI scan).
Treatment
Treatment includes relief from pain-inducing activity, stretching and slowly increasing strength training of the triceps muscles within the pain threshold.
Localising whether the injury is located in the muscle, in the fascia or in the muscle tendon is of great importance for the speed of rehabilitation. This can often be determined by clinical examination. If in doubt, ultrasound or MRI scans can pinpoint the localisation of the injury.
Surgery is usually only indicated for total tears at the tendon attachment at the tip of the ulna (olecranon ulna).
In the case of major haemorrhages or fluid accumulations (hygromas) in the muscle, these can be drained ultrasound-guided, reducing pain and promoting healing.
Complications
If the progress is not smooth, you should consider whether the diagnosis is correct, whether the rupture is worse than first thought, or whether there are complications, such as muscle haemorrhage complications. Such as complication of muscle haemorrhage.
