Triceps and Biceps Tendon Repair Surgery
The triceps muscle — the large three-headed muscle on the back of the upper arm — is responsible for extending the elbow and straightening the arm, powering movements essential for pushing, pressing, throwing, and breaking a fall. The triceps tendon attaches the muscle to the olecranon — the bony point of the elbow — and when this tendon ruptures, the result is sudden pain at the back of the elbow, an inability to straighten the arm against resistance, and significant functional loss that affects nearly every upper extremity activity. Triceps tendon ruptures are the rarest of the major upper extremity tendon injuries — far less common than biceps tendon or rotator cuff tears — but they are functionally devastating when they occur, because the triceps is the only muscle capable of actively extending the elbow, and complete ruptures will not heal without surgical reattachment.
Dr. Jonathan Glashow is a board-certified orthopedic surgeon and Clinical Associate Professor of Orthopedic Surgery at NYU Grossman School of Medicine, with fellowship training in sports medicine at the Southern California Orthopedic Institute/UCLA and a traveling shoulder fellowship under Dr. Charles Rockwood and Dr. Richard Hawkins. Triceps tendon ruptures require urgent diagnosis and early surgical repair — delayed treatment allows the tendon to retract and scar tissue to fill the gap, making repair progressively more difficult — and the rarity of the injury means that many providers do not recognize it on initial evaluation. As Chief Medical Officer for the New Jersey Devils and Philadelphia 76ers, Dr. Glashow manages acute tendon ruptures in professional athletes where rapid, accurate diagnosis and timely repair are critical for career preservation. Named a Castle Connolly Top Doctor every year since 2000, with more than 15,000 procedures performed, he treats triceps tendon ruptures at his Upper East Side practice in New York City with same-day imaging and emergency evaluation available.
Causes and Risk Factors
Triceps tendon ruptures most commonly occur during a forceful eccentric contraction — when the muscle is contracting while being forcibly lengthened. The most common mechanisms include falling onto an outstretched hand with the elbow partially flexed, forceful overhead pushing or pressing (such as a bench press or overhead press), and direct blows to the back of the elbow during contact sports. Anabolic steroid use is a recognized risk factor — as with pectoralis and distal biceps ruptures — because steroid use increases muscle strength faster than tendon strength can adapt. Corticosteroid injections near the triceps tendon insertion and certain systemic conditions that weaken tendons (chronic kidney disease, hyperparathyroidism) also increase the risk.
Symptoms of a Triceps Tendon Rupture
- Sudden, sharp pain at the back of the elbow at the time of injury
- An audible pop or snapping sensation
- Swelling and bruising at the back of the elbow and upper arm
- An inability to straighten the arm against resistance — the hallmark functional deficit
- A palpable gap or defect at the back of the elbow where the tendon has detached from the olecranon
- Weakness in pushing movements and overhead pressing
Diagnosis and Treatment
Dr. Glashow diagnoses triceps tendon ruptures through a clinical examination that assesses elbow extension strength, palpates for a gap at the tendon insertion, and evaluates the range of motion. X-rays are taken to rule out olecranon fractures — which can produce similar symptoms — and to check for avulsion fragments (small pieces of bone pulled off the olecranon by the retracting tendon). An MRI confirms the diagnosis, determines whether the tear is partial or complete, and shows the degree of tendon retraction — all of which guide surgical planning.
Complete Triceps Tears: Complete ruptures require surgical repair — without reattachment, the patient permanently loses the ability to actively extend the elbow against resistance, which profoundly limits upper extremity function. The surgery is performed through an incision over the back of the elbow. The torn tendon is mobilized, debrided of damaged tissue, and reattached to the olecranon using suture anchors, drill holes, or a combination of both. Early repair — ideally within the first two to three weeks — produces the best outcomes.
Partial Triceps Tears: Partial tears may be managed non-operatively with rest, bracing, activity modification, and a progressive physical therapy program — provided the patient retains functional elbow extension strength. Dr. Glashow monitors partial tears with clinical examination and follow-up imaging, and recommends surgical repair if symptoms persist or if the tear progresses.
Recovery After Triceps Tendon Repair
The elbow is immobilized in a hinged brace after surgery, with gentle range-of-motion exercises beginning within the first few weeks under physical therapy guidance. Active elbow extension is restricted for approximately six weeks to protect the repair. Progressive strengthening begins around eight to twelve weeks, with full return to heavy lifting and contact sports between four and six months after surgery. Dr. Glashow coordinates rehabilitation closely with physical therapists and advances each patient based on healing milestones rather than a fixed calendar.
Triceps Tendon Repair in New York City
If you have experienced a sudden pop at the back of your elbow, noticed an inability to straighten your arm against resistance, or have swelling and a palpable gap at the back of the elbow, you may have ruptured your triceps tendon — and early surgical repair produces the best outcomes. Dr. Glashow offers urgent evaluation with same-day imaging at his Upper East Side practice. Contact our office to schedule your consultation.
Frequently Asked Questions About Triceps Tendon Repair
How common are triceps tendon ruptures?
Triceps tendon ruptures are the rarest of the major upper extremity tendon injuries, accounting for less than 1 percent of all tendon ruptures. They occur far less frequently than rotator cuff tears, biceps tendon ruptures, or pectoralis major ruptures. Because of their rarity, triceps ruptures are sometimes missed on initial evaluation — the injury may be mistaken for an elbow sprain or contusion — which is why evaluation by a specialist experienced with upper extremity tendon injuries is important when elbow extension weakness is present after a traumatic event.
Do all triceps tendon tears require surgery?
Complete triceps tendon ruptures almost always require surgical repair, because without reattachment the patient permanently loses the ability to extend the elbow against resistance — an irreplaceable function that affects virtually every pushing, pressing, and stabilizing movement of the arm. Partial tears that preserve functional extension strength may be managed non-operatively with physical therapy and monitoring, but partial tears that fail to improve or progress toward complete rupture will require surgical repair.
How soon after a triceps rupture should surgery be performed?
Early repair — ideally within the first two to three weeks after injury — produces the best results. As time passes, the torn tendon retracts, scar tissue forms in the gap, and the muscle begins to shorten, all of which make delayed repair technically more difficult and may require tendon graft augmentation. If you suspect a triceps rupture, Dr. Glashow recommends urgent evaluation so that the surgical window is not missed.
What is the difference between a triceps tendon rupture and an olecranon fracture?
Both injuries can produce pain and swelling at the back of the elbow and difficulty straightening the arm. An olecranon fracture is a break in the bony point of the elbow itself. A triceps tendon rupture is a tear of the tendon that attaches to the olecranon. In some cases, a triceps rupture can pull off a small fragment of bone from the olecranon (an avulsion fracture), producing elements of both injuries simultaneously. X-rays distinguish between the two, and an MRI evaluates the tendon if needed.
How does triceps tendon repair differ from biceps tendon repair?
The two injuries affect different muscles with different functions — the triceps extends (straightens) the elbow, while the biceps flexes (bends) it and supinates (rotates) the forearm. Triceps repairs are performed through an incision at the back of the elbow, reattaching the tendon to the olecranon. Biceps repairs involve reattaching the tendon to either the radius (distal biceps) or the humerus (proximal biceps tenodesis), through incisions at the front of the elbow or shoulder. Both surgeries require early repair for optimal outcomes and follow a similar rehabilitation timeline of four to six months.
Can I return to weightlifting after triceps tendon repair?
Yes — return to weightlifting is one of the primary goals of triceps tendon repair, since the majority of triceps ruptures occur in individuals who are actively involved in strength training. Most patients are cleared for light upper body exercise around three months and progressive return to heavy lifting between five and six months after surgery. Dr. Glashow uses objective strength testing to determine when each patient is ready to resume maximum loading and advises on exercise modifications to reduce re-injury risk.
