Snapping Triceps 718.92

synonyms:

Snapping Triceps ICD-9

• 718.92 (unspecified derangement of joint; arm)

Snapping Triceps Etiology / Epidemiology / Natural History

• Has been associated with bodybuilders with hypertrophied musculature (Spinner RJ, JBJS 1998;80A:239), baseball pitching and push-ups/weightlifting

Snapping Triceps Anatomy

• Can occur from medial subluxation of the medial head of the triceps muscle or tendon over the medial epicondyle during elbow flexion, or the lateral triceps tendon subluxing over the lateral epicondyle.
• Associated bony abnormalities: hypoplastic trochlea or medial epicondyle, cubitus varus, or an elongated olecranon on the medial sid

Snapping Triceps Clinical Evaluation

• Variable pain on the medial aspect of elbow
• Evaluate for Ulnar neuropathyas well as ulnar nerve subluxation.
• Symptoms may be exacerbated by overhead activities such as pitching, push-ups, and weight lifting
• With careful palpation snapping of the triceps will be detected.

Snapping Triceps Xray / Diagnositc Tests

• A/P, lateraland oblique elbow films indicated, usually normal.
• Arthrogram MRI: consider to eval for loose bodies. MRI performed in full elbow flexion and extension demonstrating the muscle subluxed in full flexion confirms the diagnosis. (Yiannakopoulos CK. Radiology 2002;225:607).

Snapping Triceps Classification / Treatment

• Nonoperative: avoidance of activities that involve repetitive flexion and extension of elbow, NSAIDs.
• Operative: release the offending portion of triceps tendon from the medial attachment of the triceps mechanism, with lateral translation and reattachement. May require concomittant ulnar nerve transpostion if associated with ulnar neuropathy. (Spinner RJ, JBJS 1998;80A:239).

Snapping Triceps Associated Injuries / Differential Diagnosis

• Medial epicondylitis
• Medial Elbow instability / Medial collateral ligament sprain
• Ulnar neuropathy
• Elbow arthritis
• Posterior Elbow Impingement
• Flexor/pronator muscle strain
• Loose bodies
• Bicipital tendonitis
• Posterolateral rotatory instability
• Synovial Plica

Snapping Triceps Complications

• Recerrent snapping

Snapping Triceps Follow-up Care

• Splint removed at 7-10 days. Gentle elbow ROM started. Hand wrist ROM encouraged.
• Resisted wrist flexion/pronation started at 6 weeks
• Return to activity at 4 months post-op
• 100% excellent results with release and lateralization in small series. (Spinner RJ, JBJS 1998;80A:239).

Snapping Triceps Review References

• Spinner RJ, et al. Snapping of the triceps tendon over the lateral epicondyle. J Hand Surg 1999;24A:381.
• Spinner RJ, et al. Medial or lateral dislocation (snapping) of a portion of the distal triceps: a biomechanical, anatomic explanation. J Shoulder Elbow Surg 2001;10(6):561
• Spinner RJ, Goldner RD. Snapping of the medial head of the triceps and recurrent dislocation of the ulnar nerve. Anatomical and dynamic factors. J Bone Joint Surg 1998;80A:239– 47.
• Spinner RJ, et al. Episodic snapping of the medial head of the triceps due to weightlifting. J South Orthop Assoc 1999;8:288.