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
B. Bursa subcutanea acromialis
C. M. deltoideus
D. M. triceps brachii (caput laterale)
E. M. brachioradialis
F. Epicondylus lateralis
G. Olecranon (Albuespidsen)
H. Epicondylus medialis
I. M. triceps brachii (caput mediale)
J. M. triceps brachii (caput longum)
Cause
When a muscle is suddenly subjected to a force that exceeds its strength, a tear occurs, often accompanied by bleeding. In some cases, the muscle tear (contusion) and bleeding result from a direct blow to the muscle. The vast majority of muscle strains are partial muscle strains. Strains most commonly occur when a muscle contracts at the same time as it is 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).
Complete tears are very rare and are most commonly located at the point where the muscle attaches to the tip of the ulna (olecranon). When the muscle tears, and particularly if it is injured following a direct blow to the muscle, bleeding may occur within 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’). I sværere tilfælde mærkes en pludselig jagende smerte i musklen (”delvis muskelbristning”, ”fibersprængning”) og i værste fald mærkes et voldsom smæld, hvorefter strækning i albuen mod modstand er ophørt (”total muskelbristning”, som er meget sjældent).
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.
Identifying whether the injury is located in the muscle, the fascia or the tendon is crucial to the speed of recovery. This can often be determined during the clinical examination. If in doubt, ultrasound or MRI scans can reveal the location 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.