The triceps is the muscle on the back of the upper arm that straightens the elbow. Its tendon attaches to the tip of the elbow (the olecranon). A distal triceps rupture is uncommon: it accounts for only about 2% of tendon injuries.1 It usually happens when a contracting triceps is suddenly forced to bend, such as during a fall onto an outstretched hand or while blocking in football.2 It is most common in young, active men and in older adults with certain medical conditions.3 Dr. Andrew Dold, a board-certified, fellowship-trained sports medicine surgeon in Frisco, Texas, treats partial and complete triceps tears.
- Uncommon; most often in young, active men and in older adults with certain medical conditions
- Some partial tears heal without surgery
- Complete tears are usually repaired, ideally within the first 2 to 3 weeks
- Dr. Dold repairs the tendon to bone with bone tunnels or suture anchors; both work well
- About 95% of patients are satisfied after repair
Symptoms
- Sudden pain at the back of the elbow, sometimes with a pop
- Swelling and bruising
- A gap you can feel above the tip of the elbow
- Weakness straightening the elbow, especially overhead or when pushing
Triceps tears in professional football players were most often caused by an eccentric load on a contracting triceps. Some players had elbow pain beforehand, and several had received a cortisone injection.2
Diagnosis
Dr. Dold checks for a gap and tests the strength of elbow extension against resistance. X-rays may show a small “fleck” of bone pulled off with the tendon. MRI or ultrasound confirms whether the tear is partial or complete and how far the tendon has retracted, which guides treatment.
Treatment without surgery
Partial tears with good strength, and tears in lower-demand patients, can often be treated without surgery using a short period of splinting followed by progressive rehabilitation. In National Football League players, 6 of 10 partial tears healed without surgery; others later needed repair because of persistent pain and weakness or a complete tear.2 Non-surgical treatment of a complete tear typically leaves lasting weakness, which is why surgery is usually recommended for active patients.1
Surgery
For complete tears and partial tears with significant weakness, Dr. Dold recommends repair, ideally within the first 2 to 3 weeks after injury. Through an incision at the back of the elbow, the tendon is secured to the olecranon with strong sutures, using either transosseous bone tunnels or suture anchors, depending on the tear pattern and bone quality.
Both techniques work well. In a multicenter study with an average of more than 4 years of follow-up, elbow function scores averaged 94 out of 100 and did not differ between tunnel and anchor repairs.4 A systematic review of 16 studies found that 95% of patients were satisfied, with strength averaging 87% of the other side.1 In active-duty military personnel, 94% returned to duty after repair.3
Risks
Complications are not rare. A systematic review of 560 patients found an overall complication rate of about 15%, most commonly ulnar nerve symptoms, infection and pain, with re-rupture in about 2% to 4% depending on technique.5 In a large single-center series of 199 repairs, complications occurred in about 16% to 19% and reoperation in about 11% to 15%, with no significant difference between techniques.6 In the military study, every re-rupture was caused by a new injury within the first four months, which is why protecting the repair early matters.3
Late (chronic) tears
When a complete tear is found late, the tendon may scar and retract. Partial chronic tears can still do well without surgery, while complete or large chronic defects usually need reconstruction, often with a tendon graft.7
Recovery
After repair, the elbow is protected in a splint or brace, then motion is increased gradually over several weeks. Strengthening follows, and heavy pushing, lifting and contact sports are usually avoided for several months. Dr. Dold will give you a specific plan.
See also distal biceps tendon rupture, the equivalent injury at the front of the elbow.
What the research shows
Triceps tendon ruptures are uncommon, so most of the evidence comes from case series, large databases and laboratory studies. Here is what that research adds.
Outcomes and return to sport
In a database of more than 8,000 repairs, complications occurred in about 6% within 90 days and about 3% needed revision within a year. Older age, heart disease, rheumatoid arthritis, kidney disease and anabolic steroid use were linked to more problems. About 9 in 10 athletes returned to sport, on average about 6 months after surgery, although some did not reach their previous level.
Repair technique
Studies do not fully agree on the ideal repair method. A long-term multicenter study found similar function with bone tunnels and suture anchors, while a series of 184 repairs found more re-ruptures after bone tunnel repair. Laboratory studies show that repairs that restore the tendon’s full footprint on the bone are stronger. Dr. Dold chooses the technique based on the tear and the bone.
Risk factors
Steroid injections around the elbow, anabolic steroid use, heavy weightlifting and certain medical conditions are linked to triceps ruptures.
Why see Dr. Dold
- Board certified by the American Board of Orthopaedic Surgery, with subspecialty certification in Sports Medicine
- Sports medicine and arthroscopy fellowship at NYU Langone / Hospital for Joint Diseases; orthopedic residency at the University of Toronto
- Fellow of the American College of Surgeons (FACS), the American Academy of Orthopaedic Surgeons (FAAOS), the American Orthopaedic Association (FAOA) and the Royal College of Surgeons of Canada (FRCSC)
- Author of a SLAP repair book chapter (Springer, 2017) and research on shoulder suture anchors (KSSTA, 2013)
- Team physician and surgical consultant to Rugby Canada; has cared for professional athletes from the NFL, NBA, NHL, MLS, PGA Tour and Major League Rugby
- D Magazine Best Doctors (Collin County), 2019–2026 · Rated 4.9 on Google
Frequently asked questions
Does a torn triceps always need surgery?
No. Some partial tears heal without surgery.2 Complete tears in active patients are usually repaired to restore strength.
How soon should a triceps tear be repaired?
Ideally within the first 2 to 3 weeks, before the tendon scars and retracts. Late tears may need a graft.7
Which repair technique does Dr. Dold use?
He uses either bone tunnels or suture anchors depending on the tear. Studies show similar results with both.4,6
Will I get my strength back?
Most patients do well: in a systematic review, 95% were satisfied and strength averaged 87% of the other arm.1
What are the risks of surgery?
About 15% of patients have a complication, most often ulnar nerve symptoms, infection or pain; re-rupture is uncommon.5
Research cited on this page
- Tran DV, Yetter TR, Somerson JS. Surgical repair of distal triceps rupture: a systematic review of outcomes and complications. JSES Rev Rep Tech. 2022;2(3):332-339. PubMed
- Mair SD, Isbell WM, Gill TJ, et al. Triceps tendon ruptures in professional football players. Am J Sports Med. 2004;32(2):431-434. PubMed
- Balazs GC, Brelin AM, Dworak TC, et al. Outcomes and complications of triceps tendon repair following acute rupture in American military personnel. Injury. 2016;47(10):2247-2251. PubMed
- Horneff JG, Aleem A, Nicholson T, et al. Functional outcomes of distal triceps tendon repair comparing transosseous bone tunnels with suture anchor constructs. J Shoulder Elbow Surg. 2017;26(12):2213-2219. PubMed
- Alnaji O, Erdogan S, Shanmugaraj A, et al. The surgical management of distal triceps tendon ruptures: a systematic review. J Shoulder Elbow Surg. 2022;31(1):217-224. PubMed
- Brush PL, Trenchfield D, Pohl NB, et al. A comparison of distal triceps tendon repair outcomes by surgical technique. JSES Rev Rep Tech. 2024;4(4):790-796. PubMed
- Weber MM, Rausch V, Leschinger T, et al. Chronic Injuries to the Distal Biceps and Triceps Tendons: Current Evidence, Treatment Strategies, and Clinical Implications. Z Orthop Unfall. 2026;164(5):469-475. PubMed
- Lee E, Stillson QA, Seidel HD, et al. Surgical Outcomes, Trends, and Risk Factors of Distal Triceps Repairs. Hand (N Y). 2023;18(8):1300-1306. PubMed
In a cohort of 8,143 triceps repairs, the 90-day complication rate was 5.8% and the 1-year revision rate 2.6%; older age, heart disease, rheumatoid arthritis and kidney disease raised complication risk, and anabolic steroid use raised revision risk. - Agarwalla A, Gowd AK, Liu JN, et al. Return to Sport Following Distal Triceps Repair. J Hand Surg Am. 2023;48(5):507.e1-507.e8. PubMed
About 90% of patients returned to sport about 6 months after triceps repair, though roughly 30% did not return to their pre-injury level. - Mirzayan R, Acevedo DC, Sodl JF, et al. Operative Management of Acute Triceps Tendon Ruptures: Review of 184 Cases. Am J Sports Med. 2018;46(6):1451-1458. PubMed
In 184 acute triceps repairs, bone tunnel repairs had a higher re-rupture and reoperation rate than suture anchor repairs. - Haft M, MacKenzie JS, Shi BY, et al. Biomechanical strength of triceps tendon repairs: systematic review and meta-regression analysis of human cadaveric studies. Musculoskelet Surg. 2024;108(2):153-162. PubMed
A meta-analysis of laboratory studies found repair construct details, such as the number of sutures, affect repair strength. - Clark J, Obopilwe E, Rizzi A, et al. Distal triceps knotless anatomic footprint repair is superior to transosseous cruciate repair: a biomechanical comparison. Arthroscopy. 2014;30(10):1254-60. PubMed
In a cadaver study, a knotless anatomic footprint repair was stronger and moved less than a traditional bone tunnel repair. - Scheiderer B, Imhoff FB, Morikawa D, et al. The V-Shaped Distal Triceps Tendon Repair: A Comparative Biomechanical Analysis. Am J Sports Med. 2018;46(8):1952-1958. PubMed
A cadaver study compared triceps repair techniques that restore the tendon footprint and found differences in failure load between constructs. - Walker CM, Noonan TJ. Distal Triceps Tendon Injuries. Clin Sports Med. 2020;39(3):673-685. PubMed
A review listed eccentric loading, anabolic steroids, weightlifting, local steroid injections, hyperparathyroidism and olecranon bursitis as factors linked to triceps rupture. - Keener JD, Sethi PM. Distal Triceps Tendon Injuries. Hand Clin. 2015;31(4):641-50. PubMed
A review noted that the diagnosis is usually made clinically, with MRI helping to confirm the tear and plan surgery. - Yeh PC, Dodds SD, Smart LR, et al. Distal triceps rupture. J Am Acad Orthop Surg. 2010;18(1):31-40. PubMed
A review described MRI as useful to confirm and classify triceps ruptures, since pain and swelling can limit the exam. - Bennett JB, Mehlhoff TL. Triceps Tendon Repair. J Hand Surg Am. 2015;40(8):1677-83. PubMed
A review emphasized that loss of elbow extension strength is the main problem after a complete triceps rupture.
Medically reviewed by Andrew P. Dold, MD, FAOA, FAAOS, FACS, FRCSC. Last reviewed October 2026. This page is general information, not medical advice. Individual results vary.
