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Tricep Tendinitis

(Also known as Tricep Tendonitis, Tricep Tendinopathy, Tricep Tendinitis, Tricep Tendinosis)
Note - Although research suggests that 'tricep tendinopathy' is the more appropriate term to describe overuse injuries to the tricep tendon, we will use the term 'tricep tendonitis' in this document as it is more widely known.

What is tricep tendonitis?
Tricep tendonitis is a condition characterized by tissue damage to the triceps tendon causing pain in the back of the elbow.
The muscle at the back of the upper arm is known as the triceps. The triceps originates from the shoulder blade and humerus (upper arm bone) and inserts into the ulna (forearm bone) via the triceps tendon.
The triceps muscle is primarily responsible for straightening the elbow. During contraction of the triceps, tension is placed through the triceps tendon. When this tension is excessive due to too much repetition or high force, damage to the triceps tendon occurs. Tricep tendonitis is a condition whereby there is damage to the triceps tendon with subsequent degeneration and inflammation. This may occur traumatically due to a high force going through the triceps tendon beyond what it can withstand or due to gradual wear and tear associated with overuse.

Causes of tricep tendonitis
Triceps tendonitis most commonly occurs due to repetitive or prolonged activities placing strain on the triceps tendon. This typically occurs due to repetitive pushing activities or straightening the elbow against resistance (such as performing push ups or dips). Occasionally, it may occur suddenly due to a high force going through the triceps tendon beyond what it can withstand. This most commonly occurs during heavy weight lifting in a gym environment.

Signs and symptoms of tricep tendonitis

Patients with this condition typically experience pain in the back of the elbow. In less severe cases, patients may only experience an ache or stiffness in the elbow that increases with rest following activities requiring strong or repetitive contraction of the triceps muscle. These activities may include performing push ups or dips, using a hammer repetitively or punching excessively (e.g. boxing). Patients usually experience pain on firmly touching the triceps tendon.
In more severe cases, patients may experience an ache that increases to a sharper pain with activity. Occasionally patients may notice swelling at the back of the elbow and experience weakness when attempting to straighten the elbow against resistance.

Diagnosis of tricep tendonitis
A thorough subjective and objective examination from a physician is usually sufficient to diagnose tricep tendonitis. Occasionally, further investigations such as an ultrasound, X-ray or MRI scan may be required to assist with diagnosis and assess the severity.

Prognosis of tricep tendonitis
Most patients with this condition heal well with appropriate therapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had the condition for a long period of time. Early treatment is vital to hasten recovery.

Treatment for tricep tendonitis
The success rate of treatment for patients with this condition is largely dictated by patient compliance. One of the key components of treatment is that the patient rests from ANY activity that increases their pain until they are symptom free. This allows the body to begin the healing process in the absence of further tissue damage to the triceps tendon. Once the patient can perform these activities pain free, a gradual return to these activities is indicated provided there is no increase in symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. Immediate, appropriate treatment in patients with tricep tendonitis is essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
Patients with tricep tendonitis should follow RICE in the initial phase of injury. RICE is beneficial in the first 72 hours following onset or when inflammatory signs are present (i.e. morning pain or pain with rest). RICE involves resting from aggravating activities, regular icing, the use of a compression bandage and keeping the arm elevated. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
Patients with this condition should also undergo a graduated flexibility and strengthening program of the triceps to ensure an optimal outcome. The treating therapist can advise which exercises are most appropriate for the patient and when they should be commenced.

Contributing factors to the development of tricep tendonitis
There are several factors which can predispose patients to developing tricep tendonitis. These need to be assessed and corrected with direction from a therapist. Some of these factors include:
  • joint stiffness (particularly the elbow)
  • muscle tightness (particularly the triceps)
  • inappropriate or excessive training
  • inadequate warm up
  • muscle weakness
Therapy for tricep tendonitis
Therapy treatment for tricep tendonitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of recurrence. Treatment may comprise:
  • soft tissue massage
  • electrotherapy (e.g. ultrasound)
  • stretches
  • joint mobilization
  • ice or heat treatment
  • exercises to improve strength and flexibility
  • education
  • anti-inflammatory advice
  • activity modification advice
  • a gradual return to activity program

Other intervention for tricep tendonitis

Despite appropriate management, some patients with this condition do not improve adequately. When this occurs the treating doctor will advise on the best course of management. This may include further investigations such as X-rays, ultrasound, MRI or CT scan, pharmaceutical intervention, corticosteroid injection or referral to appropriate medical authorities who will advise on any interventions that may be appropriate to improve the condition.