The three heads of triceps converge in the distal arm into a broad aponeurosis that forms the distal triceps tendon, which inserts on the olecranon via a broad footprint. The central tendinous fibres insert on the posterior olecranon, while medial and lateral fascial expansions spread into the deep fascia of the forearm, the lateral expansion blending with the anconeus fascia. The footprint spans several centimetres on the olecranon, close to the articular surface.
| Muscle | |
|---|---|
| Attachment | Posterior surface of the olecranon process of the ulna |
Extends the elbow
Distal triceps avulsion is the rarest tendon rupture of the upper extremity, typically from sudden elbow flexion against a contracting triceps (fall on outstretched hand with direct elbow impact). A modified Thompson squeeze test of the triceps with the patient prone assesses tendon continuity. Partial tears of the tendon or aponeurosis cause pain with resisted extension without complete loss of function and are often treated conservatively; complete avulsions require surgical repair with suture anchors or transosseous tunnels restoring the footprint, together with the lateral expansion. The medial and lateral fascial expansions may partially maintain elbow extension even with complete central tendon avulsion, masking the diagnosis.
Forced elbow flexion against a maximally contracting triceps avulses the tendon from the olecranon footprint, producing posterior elbow pain, a palpable gap proximal to the olecranon, and weakness of elbow extension; ultrasound or MRI confirms the avulsion and surgical reattachment through transosseous tunnels or suture anchors restores extension strength.
Partial disruption of the distal tendon or aponeurosis producing posterior arm or elbow pain with resisted extension, confirmed on MRI or ultrasound and usually managed with relative rest and progressive loading.
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