Systematic Reviews
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jun 18, 2017; 8(6): 507-513
Published online Jun 18, 2017. doi: 10.5312/wjo.v8.i6.507
Distal triceps injuries (including snapping triceps): A systematic review of the literature
Kimberley Shuttlewood, James Beazley, Christopher D Smith
Kimberley Shuttlewood, James Beazley, Christopher D Smith, Royal Devon and Exeter Hospital, Exeter, Devon EX2 5DW, United Kingdom
Author contributions: Shuttlewood K literature review and contribution to script; Beazley J contribution to script; Smith CD contribution to script.
Conflict-of-interest statement: There are no conflicts of interests for any of the authors with regards to this paper.
Data sharing statement: N/A.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Correspondence to: Christopher D Smith, Shoulder and Elbow Consultant, PEOC, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, United Kingdom.
Telephone: +44-1392-406354
Received: January 28, 2017
Peer-review started: February 9, 2017
First decision: March 27, 2017
Revised: May 3, 2017
Accepted: May 8, 2017
Article in press: May 19, 2017
Published online: June 18, 2017

To review current literature on types of distal triceps injury and determine diagnosis and appropriate management.


We performed a systematic review in PubMed, Cochrane and EMBASE using the terms distal triceps tears and snapping triceps on the 10th January 2017. We excluded all animal, review, foreign language and repeat papers. We reviewed all papers for relevance and of the papers left we were able to establish the types of distal triceps injury, how these injuries are diagnosed and investigated and the types of management of these injuries including surgical. The results are then presented in a review paper format.


Three hundred and seventy-nine papers were identified of which 65 were relevant to distal triceps injuries. After exclusion we had 47 appropriate papers. The papers highlighted 2 main distal triceps injuries: Distal triceps tears and snapping triceps. Triceps tear are more common in males than females occurring in the 4th-5th decade of life and often due to a direct trauma but are also strongly associated with weightlifting and American football. The tears are diagnosed by history and clinically with a palpable gap. Diagnosis can be confirmed with the use of ultrasound (US) and magnetic resonance imaging. Treatment depends on type of tear. Partial tears can be treated conservatively with bracing and physio whereas acute tears need repair either open or arthroscopic using suture anchor or bone tunnel techniques with similar success. Chronic tears often need augmenting with tendon allograft or autograft. Snapping triceps are also seen more in men than women but at a mean age of 32 years. They are characterized by a snapping sensation mostly medially and can be associated with ulna nerve subluxation and ulna nerve symptoms. US is the diagnostic modality of choice due to its dynamic nature and to differentiate between snapping triceps tendon or ulna nerve. Treatment is conservative initially with activity avoidance and if that fails surgical management includes resection of triceps edge or transposition of the tendon plus or minus ulna nerve transposition.


Distal triceps injuries are uncommon. This systematic review examines the evidence base behind diagnosis, imaging and treatment options of distal triceps injuries including tears and snapping triceps.

Keywords: Triceps, Distal, Tear, Rupture, Snapping, Partial thickness, Biomechanical, Anatomy

Core tip: The anatomy, demographics, associations and mechanisms of triceps injuries are presented from the evidence base in the literature. Partial thickness tears and snapping triceps can be difficult to diagnose and appropriate assessment and imaging is essential. The surgical management available in the literature is presented for these uncommon injuries.