Virginia Research Day 2025

Medical Resident Research Case Reports

04 Elbow Dislocation in Collegiate Football Player: A Case of Triceps Tendon Rupture

Marissa Meyer, DO; Sean Thuesen, DO; Christopher John, MD; Briana Beach, DO Corresponding author: mbmeyer1@carilionclinic.org

Virginia Tech Carilion School of Medicine Department of Orthopedics

hearing a pop. Collateral information from his athletic trainer confirms dislocation of the elbow with need for mechanical reduction. At initial office evaluation, there was moderate posterior and medial swelling with reduced range of motion and pain with valgus stress. XR and MRI consistent with bony avulsion of the triceps and moderate to high-grade ulnar collateral ligament tear of distal attachments. Differential Diagnosis: olecranon bursitis, olecranon stress fracture, posterior impingement, intra-articular loose body, plica, lateral/medial epicondylitis, posterolateral rotatory instability Assessment/Plan: 18-year-old male presenting with right elbow pain in setting of acute trauma with transient dislocation and associated posterior fracture fragments, complete triceps tear, and partial tear of ulnar collateral ligament. Due to complete rupture

of triceps tendon, the patient underwent immediate primary repair. Intra-operative findings include retracted triceps tear with 1 x 1 cm bony fragment. At subsequent post-operative follow-up visits, the patient reported minimal pain with well healing surgical incision and gradual advancement in range of motion. Discussion: Triceps tendon rupture remains a rare injury but what makes this specific case so unique is the unusual nature of elbow dislocation and triceps tendon rupture together. It could be conceived that the athlete had a FOOSH event causing forceful eccentric contraction of the triceps with subsequent instability and dislocation. To note, the Terrible Triad is a well documented phenomenon of elbow dislocation, radial head/neck fracture, and coronoid fracture. However, there have only been a handful of documented cases that report triceps tendon rupture as a complication of elbow dislocation.

Background: Triceps tendon rupture is a rare injury accounting for less than 1% of all tendon ruptures. The most common mechanisms include forceful eccentric contraction or fall on outstretched hand. There is a 2:1 male predominance and generally occurs in 30–50-year-old weightlifters and bodybuilders. Other risk factors include ESRD, RA, SLE, diabetes, Marfan’s syndrome, osteogenesis imperfecta, hyperparathyroidism, chronic olecranon bursitis, previous triceps surgery, anabolic steroid use, local steroid injection, and fluoroquinolone use. Patients generally present with posterior elbow pain, swelling, ecchymosis, and elbow extension weakness. History/PE: 18 yo male collegiate football player with no significant past medical history presenting to injury clinic 5 days after injury of his right elbow. He reports going for a pass during practice when he fell on his outstretched hand causing hyperextension and

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