Snapping triceps syndrome: literature review, diagnosis, surgical technique, reasons for revision

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INTRODUCTION: Snapping triceps syndrome is a rare condition that may be misdiagnosed with ulnar nerve instability. It commonly affects young males who complain of painful snap on the medial side of the elbow. This snap appears when the elbow is being extended with resistance, such as during push-ups. Surgical treatment includes anterior transposition of the ulnar nerve and resection of the medial portion of triceps.

AIM: To analyze the results of surgical treatment performed on wide-awake patients using local anesthetic without tourniquet.

MATERIALS AND METHODS: Twenty-one patients were operated on 26 hands by a single surgeon between 2018 and 2023. Patients were assessed at least 6 months post-surgery via telephone calls, e-mails, and messaging apps.

RESULTS: Eleven patients were reached for follow-up. Amount of revision surgeries is 8 in this series with maximum number of 5 in one patient for both hands. Two patients are still having different issues in their elbows.

CONCLUSIONS: Snapping triceps syndrome is not easy to treat despite knowledge on this rare condition. The most common reason for revision surgery is persistent snapping even in those patients who were tested for active resisted extension during surgery. However, successful surgery may lead to full return to sport activities as none of our patients complained of loss of triceps power.

About the authors

Nikolay A. Karpinskii

ReaClinic Medical Center

Email: mail@handclinic.pro
ORCID iD: 0009-0008-8476-744X
Russian Federation, 28A, room 20-N Kolomyazhsky ave., Saint Petersburg, 197341

Ivan V. Kostenko

ReaClinic Medical Center

Author for correspondence.
Email: koostenko_1996@mail.ru
ORCID iD: 0009-0000-8615-7567
Russian Federation, 28A, room 20-N Kolomyazhsky ave., Saint Petersburg, 197341

References

  1. Vanhees M, Geurts G, Van Riet RV. Snapping triceps syndrome: a review of the literature. Shoulder & Elbow. 2010;2(1):30–33. doi: 10.1111/j.1758-5740.2009.00033.x
  2. Rioux-Forker D, Bridgeman J, Brogan DM. Snapping triceps syndrome. J Hand Surg Am. 2018;43(1):90.e1–90.e5. doi: 10.1016/j.jhsa.2017.10.014
  3. Dellon AL. Musculotendinous variations about the medial humeral epicondyle. J Hand Surg Am. 1986;11(2):175–181. doi: 10.1016/0266-7681(86)90254-8
  4. Fabrizio PA, Clemente FR. Variation in the triceps brachii muscle: a fourth muscular head. Clin Anat. 1997;10(4):259–263. doi: 10.1002/(SICI)1098-2353(1997)10:4<259::AID-CA8>3.0.CO;2-N
  5. Spinner RJ, An KN, Kim KJ, Goldner RD, O’Driscoll SW. Medial or lateral dislocation (snapping) of a portion of the distal triceps: a biomechanical, anatomic explanation. J Shoulder Elbow Surg. 2001;10(6):561–567. doi: 10.1067/mse.2001.118006
  6. Kontogeorgakos VA, Mavrogenis AF, Panagopoulos GN, et al. Cubitus varus complicated by snapping medial triceps and posterolateral rotatory instability. J Shoulder Elbow Surg. 2016;25(7):e208–e212. doi: 10.1016/j.jse.2016.03.012
  7. Spinner RJ, Davids JR, Goldner RD. Dislocating medial triceps and ulnar neuropathy in three generations of one family. J Hand Surg Am. 1997;22(1):132–137. doi: 10.1016/S0363-5023(05)80193-5
  8. Jeon IH, Liu H, Nanda A, et al. Systematic review of the surgical outcomes of elbow plicae. Orthop J Sports Med. 2020;8(10):2325967120955162. doi: 10.1177/2325967120955162
  9. Boon AJ, Spinner RJ, Bernhardt KA, et al. Muscle activation patterns in snapping triceps syndrome. Arch Phys Med Rehabil. 2007;88(2):239–242. doi: 10.1016/j.apmr.2006.11.011
  10. Chuang HJ, Hsiao MY, Wu CH, Özçakar L. Dynamic ultrasound imaging for ulnar nerve subluxation and snapping triceps syndrome. Am J Phys Med Rehabil. 2016;95(7):e113–e114. doi: 10.1097/PHM.0000000000000466
  11. Spinner RJ, Goldner RD. Snapping of the medial head of the triceps: diagnosis and treatment. Tech Hand Up Extrem Surg. 2002;6(2):91–97. doi: 10.1097/00130911-200206000-00008

Supplementary files

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1. JATS XML
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2. Clinical features of snapping triceps syndrome
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3. Intraoperative video demonstrating the ulnar nerve transposed anteriorly from the medial epicondyle, placed under a fascial Z-flap
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4. Intraoperative video showing the ulnar nerve mobilised and moved anteriorly from the medial epicondyle and the result of medial portion of triceps brachii tendon marginal resection
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5. Fig. 1. Photograph of the proximal aspect of the posterior compartment of the left arm demonstrating the proximal attachment of the fourth head of the triceps brachii tendon (T) in relation to the radial nerve (R), deep brachial artery (B), long head muscle belly (L) and lateral head muscle belly (A) [4].

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6. Fig. 2. Photograph of the distal aspect of the posterior compart-ment of the left arm demonstrating the muscle belly of the fourth head of the triceps brachii muscle (M) and the tendon of the fourth head (T) in relation to the muscle belly of the long head (L) and the muscle belly of the lateral head (A) and the ulnar nerve (U) [4].

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7. Fig. 3. a — clinical photograph at presentation shows obvious right cubitus varus deformity. Preoperative anteroposterior radiographs of the right (R) and left (L) elbows show a humerus-elbow-wrist angle of (b) 12° varus on the right elbow compared with (c) 8° valgus on the left elbow [6].

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8. Fig. 4. The T angle summates the direction of pull of the 3 heads of the triceps (Т1, Т2, and Т3) and represents the line of pull of the entire triceps to its position of attachment [5].

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9. Fig. 5. Ultrasonographic imaging of the medial elbow (short-axis view): a — in elbow extension, the ulnar nerve (arrowhead) is located between the medial epicondyle of humerus (ME) and the olecranon of ulna (O), the ulnar nerve apppears as swollen and hypoechoic; b — during elbow flexion, the ulnar nerve (arrowhead) and medial portion of the triceps muscle (Tr) slide anteriorly over the medial epicondyle (ME) [10].

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10. Fig. 6. Intraoperative photograph: mobilized ulnar nerve.

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11. Fig. 7. Intraoperative photograph: the ulnar nerve is transposed and placed under a fascial Z-flap.

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