Minimally Invasive Tenotomy for Chronic Tendinosis of the Triceps Brachii: A Case Report

Case Diagnosis: 45-year-old male with chronic distal triceps brachii tendinosis who was successfully treated with minimally invasive tenotomy.

Case Description or Program Description: 45-year-old male was seen in an outpatient sports medicine clinic for evaluation of chronic dull and aching posterior elbow pain present for several years. On exam, there was full passive and active range of motion in the wrist, elbow and neck. Strength was preserved throughout the left upper extremity, except there was pain and associated weakness with resisted arm extension. Initial radiologic imaging of the left elbow showed a large, fragmented olecranon enthesophyte versus intra-tendinous calcification. Follow-up magnetic resonance imaging showed moderate to severe distal triceps tendinosis without high grade tearing.

Setting: Sports Medicine Outpatient Clinic

Assessment/Results: Given the chronicity of the symptoms and minimal response to conservative treatment thus far, multiple management options were discussed with the patient and ultimately patient decided to move forward with a minimally invasive tenotomy. One month after the procedure, patient was seen for follow-up and reported significantly improved pain and has been cleared to slowly progress towards normal activities.

Discussion (relevance): Distal triceps tendon injuries are rare and not much is known about the treatment and management of triceps tendinosis. Conservative treatment measures include activity modification and physical therapy. Nonsteroidal anti-inflammatory drugs have not shown long-term benefits and corticosteroid injections are contraindicated due to their risk factor of a tendon rupture. When these options fail, surgical options are limited given the lack of evidence. Tenotomy is a less-invasive option that has shown some promise as another treatment option in treating this injury (one case report and a case series of 5 patients).

Conclusions: Minimally invasive tenotomy is a potential treatment option for chronic triceps tendinosis, especially for those who have failed more conservative measures.