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
Repeated overloading of the flexor-extensor function in the elbow (e.g. weight lifting, strength training, racket sports, swimming) can cause overuse injuries to the triceps muscle at the attachment (enthesitis) of the elbow (olecranon). With repeated (over)strain, the tendon can become ‘inflamed’ (inflamed). Long-term inflammation of the tendon (tendinitis) increases the risk of rupture, which is very rare.
Symptoms
Pain at the triceps muscle attachment at the back of the elbow (olecranon). The pain is aggravated by activation of the triceps muscle.
Examination
The diagnosis is usually made during a general clinical examination. Symptoms can be provoked by pressure on the triceps tendon attachment on the olecranon and by trying to extend the elbow against resistance. If there is any doubt about the diagnosis, an ultrasound scan can be performed.
Treatment
Treatment includes relief from pain-inducing activity, stretching and slowly increasing strength training of the upper arm muscles within the pain threshold. If the discomfort does not subside during rehabilitation, treatment can be supplemented with medical treatment in the form of arthritis pills (NSAIDs) or adrenal cortex hormone injections as part of an often 3-6 months slow rehabilitation within the pain threshold before maximum load is allowed.
Surgical treatment is only indicated for total rupture of the triceps tendon, which is very rare, to avoid significant impairment of elbow extension. Re-ruptures and surgical complications are relatively frequent (Alnaji O, et al. 2022).
Complications
If no progress is made, you should reconsider whether the diagnosis is correct or if complications have arisen.
In particular, the following should be considered:
- Inflammation of the bursa at the elbow,
- Rheumatoid arthritis in the elbow joint,
- Ligament ruptures on the inside and outside of the elbow,
- Damage to the ulnar and median nerves
- Thrower’s elbow (discomfort triggered from the elbow joint itself and joint capsule)
- Muscle rupture
