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Forum Name: Bone trauma and fractures

Question: Tricep avulsion


 Lucion - Mon May 11, 2009 10:18 pm

Hi,
My son fell off a handrail 3 months ago and almost completely tore his tricep tendon from the olecranon. This was misdiagnosed for 3 weeks as soft tissue damage, so he had no treatment other than a sling. He finally (after much pushing from me to get secondary x-rays and an ultrasound) was correctly diagnosed and had surgery to reattach the tricep tendon.
After surgery he had a half cast for 3 weeks then a splint for 4 weeks with no exercise of the arm.
He's now undergoing light physiotherapy with minimal progress, he can almost fully open his arm but can close it to only approx 90 degrees.
His doctors have been very vague about his eventual recovery, even though I've asked them every time I see them.
My question is how long (generally speaking) does it take til you know it's as good as it's going to get? I (and my son) are prepared for whatever we get told, whether it's that it won't improve anymore, or it'll take 12 months to regain maximum flexibility.
I understand this is a very rare injury, but any insight or advice would be tremendously appreciated.
Thank you.
 Tom Plamondon PA-C - Tue Jun 09, 2009 6:55 am

User avatar Hello,
His progress actually sounds pretty good - almost full extension and 90 degrees flexion.

You are correct that this is an uncommon injury.

He will likely have some deficit in the elbow to what degree I do not know. It depends on his age, his activity level, his dedication to rehab and any re-injury.

I would expect the range of motion to reach 90% of normal. At some point the stretching for flexion will need to be aggressive (but wait until the surgeon gives the ok - the reattached tendon must be fully healed before cranking on the elbow). The strength will come but will take 8-12 weeks. So I would anticipate rehab will be for 6 months. Come Decemeber/January he will have reached maximum potential.

Take care.
 Lucion - Tue Jun 16, 2009 6:06 pm

Thank you so much for your reply Tom.
Since this happened I have scoured the internet for information, of which there is relatively little. I truly appreciate the time you took for your response.
Since first writing, my son has gained perhaps 5 degrees further flexion. He's now on a bit more intensive rehab, previously he was just flexing and relaxing his arm with no pressure. Now they have him using a 2 kilogram weight and also applying some pressure to his arm during flexion exercises.
He's only 16 but has been very good at maintaining his own exercise regime which is a miracle within itself as 16 year olds normally need reminding 85 times to do anything !
I did allow him to start using his skateboard again about a month ago as he really missed it, but after splitting his chin open and another trip to the emergency room the skateboards off limits. Although the chin injury happened because as he fell he instictively didn't put his injured arm down to stop himself.

Thanks again for your response, take care, Kelly.
 Tom Plamondon PA-C - Sun Jul 12, 2009 8:33 pm

User avatar Good to hear he is making progress with his rehab.
Take care.
 Lucion - Mon Jan 11, 2010 12:06 pm

My son has finally made a full recovery, but only after a second surgery.

After making no further progress in movement for almost 8 months I consulted an orthopaedic surgeon who was brilliant. He discovered further irregularities in my sons injury, most tricep avulsion recovery limitations are in extension, whereas my son could fully extend, but couldn't flex past the 90 degrees.
Following the first surgery his arm was completely immobilised for 8 weeks.
The surgeon re-opened the initial incision site and discovered that the immobilisation had caused the whole elbow to be 'gunked' up with scar tissue, which he then cut out. Then forced my sons arm into full flexion, strapping it there for 2 days.
After 2 months of aggressive physiotherapy 3 times a week his arms finally back to normal.

I'd urge anybody reading this with a similar injury to not settle for a possible permanent disability. I had 4 different consultations who said that my son just had to learn to live with it. All it took was one specialist who cared enough to research the problem, be convinced that it was worth opening his arm up again to see if he could discover what the problem was, he even rearranged his whole surgical schedule to bump the procedure from a 7 month waiting list to 2 weeks.

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