Overview
The triceps is the only muscle that straightens the elbow, and its tendon anchors to the olecranon, the bony point at the back of the joint. A tear there, usually from a fall onto an outstretched hand or a sudden load against a bent elbow, removes the ability to push: getting up from a chair, a bench press, breaking a fall. Distal triceps repair reattaches the tendon to the olecranon so extension strength returns.
These are uncommon tears and are often missed at first, because a swollen elbow that can still be straightened slowly by gravity is easy to call a sprain. Repaired within a few weeks, the outcome is reliable, with strength close to the other side by four to five months. The operation is done as an outpatient at Bayside Surgery Center in Coconut Grove.
Who It's For
Repair is recommended for a complete distal triceps tear, and for a partial tear of more than about half the tendon in anyone who needs pushing strength: weightlifters, contact athletes, overhead workers. Dr. O'Donnell advises operating within two to three weeks of injury, before the tendon retracts and scars.
Partial tears of less than half the tendon with preserved extension against gravity are treated with a brief splint near full extension, then graded motion and strengthening; most heal without surgery. Prior steroid injections, anabolic steroid use, kidney disease and an olecranon spur make the tendon tear more easily and affect how a repair heals. A fracture through the olecranon is a different injury, treated by fracture fixation.
A signal change or a bone fleck on imaging is not by itself the reason to repair a triceps. Dr. O'Donnell recommends surgery when the palpable gap, weakness of extension against resistance and the MRI describe the same complete or large partial tear, and the patient needs pushing strength; smaller tears are splinted and rehabilitated first. The distal triceps tear page explains the assessment.
What the Procedure Involves
Surgery takes about an hour under a regional nerve block with general anesthesia or sedation. Dr. O'Donnell makes an incision along the back of the elbow, curved to one side of the olecranon so the scar does not sit on the point you lean on. The torn tendon is trimmed to healthy tissue and secured with locking sutures woven up into the muscle.
The olecranon footprint is cleared to bleeding bone and the tendon is pulled down onto it. Fixation is either transosseous, with sutures passed through drilled bone tunnels, or with suture anchors set into the olecranon; the two are often combined so the tendon is held flat and broad against the bone rather than at a single point. Anchors avoid knots under thin skin; bone tunnels are stronger in soft bone. Where a tendon has retracted for months and cannot reach, a hamstring graft or a flap of triceps tissue bridges the gap.
The elbow is braced near full extension so the repair sits without tension, and you go home the same day.
Risks & How They Are Minimized
The skin over the olecranon is thin with a poor blood supply, so wound problems are the most frequent complication of surgery at the back of the elbow. The incision is placed off the point, knots are buried away from the skin, and you are asked not to lean on the elbow for six weeks. Infection is uncommon and is covered by a pre-incision antibiotic and a dry dressing for 48 hours.
Re-rupture usually follows a push or a fall in the first six weeks, before the tendon has healed to bone, which is why the brace limits flexion and resisted extension is banned until then. Ulnar nerve irritation, felt as tingling in the ring and little fingers, is avoided by identifying the nerve at the start and keeping it out of the field. Stiffness, particularly loss of full flexion, is minimized by the graded brace schedule rather than immobilizing the elbow. Prominent knots can occasionally be felt under the skin and are removed once the tendon has healed if they bother you. Blood clots after arm surgery are rare and need no routine medication.
Recovery & Rehabilitation
The tendon needs about six weeks to heal to bone, and until then the two things that stretch or load it, deep bending and pushing, are controlled. A hinged brace starts near extension and is opened progressively so motion returns without loading the repair.
| Phase | Timing | What happens |
|---|---|---|
| Protection | Weeks 0–2 | Hinged brace limiting flexion, near extension early. Active-assisted elbow motion within brace limits, unresisted forearm rotation, shoulder, wrist and hand motion. No resisted extension, no weight through the arm. |
| Progressive motion | Weeks 2–6 | Flexion advanced per the brace schedule toward full. Active, unresisted elbow and forearm motion; scar management. Still no resisted extension. |
| Strengthening | Weeks 6–12 | Light resisted extension begins at 6–8 weeks and progresses gradually. Grip and forearm strengthening, endurance work. |
| Return to activity | Months 3–5 | Advanced strengthening, sport- or job-specific progression. Heavy lifting, pressing and contact sport at 4–5 months, once strength is symmetric. |
Desk work is possible within the first week with the brace on; driving at two to three weeks, once you are off narcotic pain medication and the brace allows enough flexion to reach the wheel. Push-ups and bench press wait until strengthening is well under way, and full lifting and sport come at four to five months.
Protocol summary
The precautions are a hinged elbow brace with flexion limited early and advanced gradually, no resisted elbow extension for six to eight weeks, no weight bearing through the arm or lifting until cleared, and no forceful passive flexion. Unresisted motion within the brace begins in the first days.
Progression is criteria-based: wound healing and comfort within the allowed range to begin advancing flexion, near-full flexion with full unresisted active extension to begin strengthening at six weeks, and full motion with improving strength to enter the return-to-activity phase at three months. Symmetric strength is the criterion for heavy lifting and sport at four to five months; Dr. O'Donnell slows the schedule where tissue quality or fixation calls for it.
Physical Therapy Protocol
Distal Triceps Tendon Repair PDF ↗Frequently Asked Questions
Can a torn triceps heal on its own?
A partial tear of less than about half the tendon, with the ability to straighten the elbow against gravity, usually heals with a splint and graded therapy. A complete tear does not reattach itself; the muscle retracts and the arm stays weak pushing, so a complete tear, or a large partial tear in someone who lifts or plays sport, is usually repaired within a few weeks.
How do I know if I tore my triceps?
Typical signs are a pop at the back of the elbow during a fall or heavy push, bruising over the olecranon, a gap you can feel just above the bony point, and difficulty straightening the elbow against resistance or overhead. X-rays can show a fleck of bone pulled off with the tendon, and MRI shows how much is torn and how far it has retracted.
How long is recovery after triceps tendon surgery?
About six weeks in a hinged brace while the tendon heals to bone, with flexion opened week by week. Resisted extension starts at six to eight weeks, and heavy lifting, pressing and contact sport return at four to five months per the protocol. Desk work is possible within the first week.
When can I drive after distal triceps repair?
Usually two to three weeks after surgery, once you are off narcotic pain medication and the brace allows enough bend to reach the wheel. Steering does not load the triceps, but pushing yourself up out of the seat does, so use the other arm to get in and out of the car for the first six weeks.
Will I get full strength back after triceps repair?
After a prompt repair and full rehabilitation, extension strength typically returns close to the other side, and most patients get back to full pressing and sport. Repairs delayed by months, or needing a graft to bridge a retracted tendon, recover less predictably. Full flexion returns in almost all patients when the brace schedule is followed.
This page is for general education and is not a substitute for a medical evaluation. The right procedure depends on your individual diagnosis, anatomy, and goals. Kevin O'Donnell, MD sees patients from Coral Gables, Miami, Brickell, Pinecrest and Coconut Grove at 475 Biltmore Way, and out-of-town patients by telemedicine.