Triceps Tendinitis

What is Triceps Tendinitis

Triceps tendinitis is inflammation of the triceps tendon, which is located behind the elbow. The triceps tendon is a strong cord of tissue that connects the triceps muscle, on the back of the upper arm, to a bone in the elbow (ulna).

The triceps muscle helps to bend and straighten the elbow. Triceps tendinitis can interfere with your ability to do both of these movements. This condition is usually caused by overuse of the triceps muscle or injury to the upper arm. In most cases, triceps tendinitis heals within 6 weeks.

Triceps tendinitis may include a grade 1 or grade 2 strain of the tendon. A grade 1 strain is mild, and it involves a slight pull of the tendon without any stretching or noticeable tearing of the tendon. There is usually no loss of triceps muscle strength. A grade 2 strain is moderate, and it involves a small tear in the tendon. The tendon is stretched, and triceps strength is usually decreased.

Triceps tendinitis is being seen with increasing frequency in clinical practice as exercising and the use of exercise equipment have increased in popularity.

The triceps tendon is susceptible to the development of tendinitis at its distal portion and its insertion on the ulna. The triceps tendon is subject to repetitive motion that may result in microtrauma, which heals poorly because of the tendon’s avascular nature.

Exercise is often implicated as the inciting factor of acute triceps tendinitis. Tendinitis of the triceps tendon frequently coexists with bursitis of the associated bursae of the tendon and elbow joint, creating additional pain and functional disability. Calcium deposition around the tendon may occur if the inflammation continues, making subsequent treatment more difficult. Continued trauma to the inflamed tendon ultimately may result in tendon rupture

What are the causes?

This condition may be caused by:

  • Overuse of the triceps muscle.
  • A direct, forceful hit or injury (trauma) to the triceps tendon.

What increases the risk?

This condition is more likely to develop in:

  • People who participate in sports or activities that require sudden tightening (contraction) of the triceps muscle, such as biking or motorcycle riding.
  • People who participate in sports that involve moving the arm against resistance, such as weight lifting or bodybuilding.
  • People who have poor strength and flexibility of the arm and shoulder.
  • People who use steroids.

What are the symptoms?

Symptoms of this condition may include:

  • Pain and inflammation in the back of the elbow and the back of the upper arm. Pain may get worse when you try to straighten the elbow.
  • Bruising (contusion) in the back of the elbow and the back of the upper arm. This may develop 24–48 hours after trauma, if this applies.
  • Decreased triceps muscle strength, especially when straightening the elbow or gripping objects.
  • A crackling sound (crepitation) when you move or touch the elbow or the upper arm.

In some cases, symptoms may return (recur) after treatment, and they may be long-lasting (chronic).

The onset of triceps tendinitis is usually acute, occurring after overuse or misuse of the elbow joint. Inciting factors include playing tennis and aggressive use of exercise machines. Improper stretching of triceps muscle and triceps tendon before exercise also has been implicated in the development of triceps tendinitis and acute tendon rupture.

Injuries ranging from partial to complete tears of the tendon can occur when the distal tendon sustains direct trauma while it is fully flexed under load or when the elbow is forcibly flexed while the arm is fully extended. The pain of triceps tendinitis is constant and severe and is localized in the posterior elbow. Significant sleep disturbance is often reported.

Patients with triceps tendinitis exhibit pain with resisted extension of the elbow. A creaking or grating sensation may be palpated when passively extending the elbow. As mentioned, a chronically inflamed triceps tendon may rupture suddenly with stress or during vigorous injection procedures inadvertently injected into the substance of the tendon. With triceps tendon rupture, the patient is unable to fully and forcefully extend the affected arm.

How is this diagnosed?

This condition is diagnosed based on your symptoms, your medical history, and a physical exam. You may have tests, including X-rays or MRIs. Your health care provider may test your range of motion by asking you to do arm movements.

Plain radiographs, ultrasound imaging, and magnetic resonance imaging (MRI) are indicated for all patients who present with posterior elbow pain. Based on the patient’s clinical presentation, additional tests, including complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing, may be indicated.

MRI and ultrasound imaging of the elbow are indicated if joint instability is suspected and to confirm the diagnosis. Radionuclide bone scanning is useful to identify stress fractures of the elbow not seen on plain radiographs.

How is this treated?

This condition is treated by resting and icing the injured area, and by doing physical therapy exercises. Depending on the severity of your condition, treatment may also include:

  • Over-the-counter or prescription medicines that help to relieve pain and inflammation.
  • Keeping the elbow in place for a period of time (immobilization). This may be done by wearing a brace or a sling on your elbow. In rare cases, an elbow cast may be needed.
  • Surgery to repair (reconstruct) the triceps tendon. This is rare.

Follow these instructions at home:

If you have a brace or sling:

  • Wear it as told by your health care provider. Remove it only as told by your health care provider.
  • Loosen the brace or sling if your fingers tingle, become numb, or turn cold and blue.
  • Do not let your brace or sling get wet if it is not waterproof.
  • Keep the brace or sling clean.

If you have a cast:

  • Do not stick anything inside the cast to scratch your skin. Doing that increases your risk of infection.
  • Check the skin around the cast every day. Report any concerns to your health care provider.
  • You may put lotion on dry skin around the edges of the cast. Do not apply lotion to the skin underneath the cast.
  • Do not let your cast get wet if it is not waterproof.
  • Keep the cast clean.


  • If you have a cast, brace, or sling, do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you can take showers. You may only be allowed to take sponge baths for bathing.
  • If you have a cast, brace, or sling that is not waterproof, cover it with a watertight covering when you take a bath or a shower.

Managing pain, stiffness, and swelling

  • If directed, apply ice to the injured area:
    • Put ice in a plastic bag.
    • Place a towel between your skin and the bag.
    • Leave the ice on for 20 minutes, 2–3 times a day.
  • Move your fingers often to avoid stiffness and to lessen swelling.
  • Raise (elevate) the injured area above the level of your heart while you are sitting or lying down.
  • If directed, apply heat to the affected area before you exercise. Use the heat source that your health care provider recommends, such as a moist heat pack or a heating pad.
    • Place a towel between your skin and the heat source.
    • Leave the heat on for 20–30 minutes.
    • Remove the heat if your skin turns bright red. This is especially important if you are unable to feel pain, heat, or cold. You may have a greater risk of getting burned.


  • Do not drive or operate heavy machinery while taking prescription pain medicines.
  • Ask your health care provider when it is safe to drive if you have a cast, brace, or sling on your arm.


  • Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
  • Do not lift anything that is heavier than 10 lb (4.5 kg) until your health care provider tells you that it is safe.
  • Avoid activities that cause pain or make your condition worse.
  • Do exercises as told by your health care provider.

General instructions

  • If you have a cast, do not put pressure on any part of the cast until it is fully hardened. This may take several hours.
  • Take over-the-counter and prescription medicines only as told by your health care provider.
  • Keep all follow-up visits as told by your health care provider. This is important.

How is this prevented?

  • Warm up and stretch before being active.
  • Cool down and stretch after being active.
  • Give your body time to rest between periods of activity.
  • Make sure to use equipment that fits you. Wear a brace or tape your arm when playing contact sports, as told by your health care provider.
  • Be safe and responsible while being active to avoid falls.
  • Do at least 150 minutes of moderate-intensity exercise each week, such as brisk walking or water aerobics.
  • Maintain physical fitness, including:
    • Strength.
    • Flexibility.
    • Cardiovascular fitness.
    • Endurance.

Contact a health care provider if:

  • You have symptoms that get worse or do not get better after 2 weeks of treatment.
  • You develop new symptoms.

Get help right away if:

  • You develop severe pain.
  • You develop numbness or tingling in your hand.
  • Your hand feels unusually cold.
  • Your fingernails turn a dark color, such as blue or gray.

Triceps Tendinitis Rehabilitation

Ask your health care provider which exercises are safe for you. Do exercises exactly as told by your health care provider and adjust them as directed. It is normal to feel mild stretching, pulling, tightness, or discomfort as you do these exercises, but you should stop right away if you feel sudden pain or your pain gets worse. Do not begin these exercises until told by your health care provider.

Stretching and range of motion exercises

These exercises warm up your muscles and joints and improve the movement and flexibility of your arm. These exercises can also help to relieve pain, numbness, and tingling.

Exercise A: Elbow flexion, passive

  1. Stand or sit with your left / right arm at your side.
  2. Gently push your left / right arm toward your shoulder using your other hand. Bend your elbow as far as your health care provider tells you to. You may be instructed to try to bend your elbow more and more each week.
  3. Hold for __________ seconds.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise B: Elbow extension, passive, supine

  1. Lie on your back on a firm surface.
  2. Place a folded towel under your left / right upper arm, so your elbow and shoulder are at the same height and your elbow does not touch the surface that you are lying on.
  3. Move your left / right arm out to your side, keeping your elbow bent.
  4. Slowly straighten your elbow until you feel a stretch on the inside of your elbow. Keep your arm and chest muscles relaxed.
  5. Hold for __________ seconds.
  6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Strengthening exercises

These exercises build strength and endurance in your arm. Endurance is the ability to use your muscles for a long time, even after they get tired.

Exercise C: Elbow flexion, supinated

  1. Sit on a stable chair without armrests, or stand.
  2. Hold a __________ weight in your left / right hand, or hold an exercise band with both hands. You palms should face up toward the ceiling at the starting position.
  3. Bend your left / right elbow and move your hand up toward your shoulder. Keep your other arm straight down, in the starting position.
  4. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise D: Elbow extension

  1. Lie on your back.
  2. If instructed, hold a __________ weight in your left / right hand.
  3. Bend your left / right elbow to an “L” shape (90 degrees) so your elbow is pointed up toward the ceiling and the weight is over your head.
  4. Straighten your left / right elbow, raising your hand toward the ceiling. Use your other hand to support your left / right upper arm and to keep it still.
  5. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Exercise E: Scapular retraction

  1. Sit in a stable chair without arms, or stand.
  2. Secure an exercise band to a stable object in front of you so the band is at shoulder height.
  3. Hold one end of the exercise band in each hand.
  4. Squeeze your shoulder blades together and move your elbows slightly behind you. Do not shrug your shoulders.
  5. Hold for __________ seconds.
  6. Slowly return to the starting position.

Repeat __________ times. Complete this exercise __________ times a day.

Differential Diagnosis

Triceps tendinitis generally is easily identified on clinical grounds, but coexistent bursitis may confuse the diagnosis. Stress fractures of the olecranon also may mimic triceps tendinitis and may be identified on plain radiographs or radionuclide bone scanning.


Trauma to the triceps tendon from the injection itself is possible. Tendons that are highly inflamed or previously damaged are subject to rupture if they are directly injected. This complication can be greatly decreased if the clinician uses gentle technique and stops injecting immediately if significant resistance to injection is encountered. Approximately 25% of patients report a transient increase in pain after this injection technique, and patients should be warned of this possibility.

Clinical Pearls

The triceps tendon is a very strong tendon, but it is also very susceptible to rupture.

Coexistent bursitis and arthritis also may contribute to posterior elbow pain and may require additional treatment with a more localized injection of local anesthetic and methylprednisolone acetate.

Injection of the triceps tendon is a safe procedure if careful attention is paid to the clinically relevant anatomy in the areas to be injected. The use of physical modalities, including local heat and gentle range-of-motion exercises, should be introduced several days after the patient undergoes this injection technique for elbow pain. Vigorous exercises should be avoided because they would exacerbate the patient’s symptoms. Simple analgesics and NSAIDs may be used concurrently with this injection technique.


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