Triceps Tendonitis – Pain near shoulder. Causes, Symptoms and Treatment

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Written By Dr. Marcus Yu Bin Pai

MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.

Triceps tendonitis is a condition involving inflammation of the triceps muscle. This disorder is relatively common and usually requires a period of 3 to 6 months to resolve fully. The prognosis for triceps tendonitis is generally good when appropriate treatment is administered (Gabel, 1999).

The condition is characterized by pain, swelling, and weakness in elbow extension. This can be particularly evident in cases of triceps tendon rupture, a more severe but rare orthopaedic injury that involves a complete tear of the triceps tendon.

The rupture often results from a forceful contraction of the triceps muscle, especially against a flexed elbow, and can be associated with activities such as weight lifting, corticosteroid injections, or chronic olecranon bursitis. These injuries can occur in both men and women of varying ages and are much less frequent compared to other tendon injuries (Bunshah et al., 2015; Weistroffer et al., 2003; Vidal & Allen, 2003).

Triceps muscle

The triceps brachii muscle originates at the humerus and scapula in the back of the shoulder and connects to the forearm’s ulna. Its primary function is to straighten the arm by extending the elbow joint.

The triceps brachii muscle is a complex structure with several distinct characteristics in its anatomy. It consists of three heads: the long, lateral, and medial heads. The activation sequence of these heads typically begins with the medial, followed by the lateral, and finally the long head. The muscle fibers of the triceps vary in type, with lower efforts preferentially recruiting type 1 fibers and higher efforts engaging larger type 2 fibers (Noto et al., 2019).

The long head of the triceps brachii has a unique neurovascular anatomy, which allows it to be used as a free functioning muscle transfer for elbow flexion. This distinct anatomy enables its transposition to enhance elbow flexion in certain medical conditions like brachial plexus sequelae (Naidu et al., 2007; Vergara-Amador & Vela-Rodríguez, 2016).

Furthermore, the triceps brachii muscle tendon (TBMT) exhibits a distal pre-tricipital space near its insertion site in the olecranon. This particular anatomical feature is important for understanding the muscle’s function and potential pathologies (Akamatsu et al., 2020).

Additionally, the medial head of the triceps has a distinct tendon that is deep to the common tendon of the long and lateral heads. Despite this distinction, their insertions converge at the olecranon (Madsen et al., 2006).

Tendon irritations and triceps injury

However, excessive movements can cause tendon problems, generating tendon irritations and joint pain. Tendonitis is characterized especially by inflammation of the tendon. It is very recurrent in regions such as the wrist, ankle, and shoulder, to name some regions most affected by discomfort[1]Jafarnia K, Gabel GT, Morrey BF. Triceps tendinitis. Operative techniques in Sports Medicine. 2001 Oct 1;9(4):217-21..

The triceps region can also suffer from tendon inflammation, even with some predominant areas which tendonitis affects. The triceps is located at the back of the arm, a part of constant movement, whether in our daily tasks or even during the practice of an exercise, such as weight training, for example, and is responsible for the extension movement of the joint.

In cases where triceps tendonitis, the tendon that is attached to the muscle (triceps) that has three heads is called the olecranon. This region of the ulna that is connected to the elbow can be inflamed when suffering trauma that will consequently affect the tendon.

Most Common Causes of Triceps Injury

Tendonitis in the triceps region is a more difficult injury to occur compared to lateral epicondylitis and medial epicondylitis, for example. However, the leading causes that generate triceps tendonitis are excessive physical exertion of the joint, in this region’s case, the arm’s extension movement.

The problem is quite recurrent in people who practice shooting sports or who require arm extension and flexion, such as in tennis, where the athlete uses the extensor movement to hit the ball with the racket.

During weight training, as already mentioned, the athlete can also suffer from triceps tendonitis, although biceps tendonitis, caused by the exhaustion of tendon tissue, is more frequent. However, in addition to athletes, people who do not have an active life in physical activity.

The main reason behind these injuries is the arm’s repetitive and excessive physical exertion, that is, the extension movements of the arm. That’s why it tends to affect many teachers and athletes.

Sports such as volleyball, tennis, and basketball, or physical activities such as weight training, are practices that easily cause tendonitis and other arm injuries.

  1. Overuse and Trauma: Overuse and direct or indirect trauma, particularly with sudden eccentric loading, are primary causes of triceps injury (Vandenberghe & Riet, 2016). Such injuries can be exacerbated by repeated strong physical efforts or a fall on an outstretched forearm.
  2. Athletic Injury: Athletic activities, especially weightlifting, are a significant cause of triceps tendon injuries. In a study, 29% of patients with triceps tendon injury reported the cause as weightlifting (Koplas, Schneider & Sundaram, 2011).
  3. Mechanisms of Injury: Common mechanisms include direct elbow trauma, extension/lifting exercises, overuse, and hyperflexion or hyperextension of the elbow. These mechanisms account for a significant portion of triceps tendon injuries, with direct elbow trauma being the most common (Waterman et al., 2018).
  4. Forceful Eccentric Contraction: This type of muscle contraction is a common cause of triceps injury, leading to weakness and pain (Stucken & Ciccotti, 2014).
  5. Fall or Direct Contact Injuries: Falls onto an outstretched hand or direct contact injuries are also reported mechanisms for triceps tendon rupture (Jaiswal et al., 2016).
  6. Rare Causes: Triceps injuries can also result from systemic causes like alcoholism, anabolic steroid use, or chronic metabolic disorders, especially in patients on hemodialysis (Denzine & Kazanjian, 2016); (Zaidenberg et al., 2015).

Triceps pain after a workout

Many people, especially beginners, feel their bodies sore after training. This pain can appear right after exercise or up to 24 hours later, which is normal.

Post-workout muscle pain reflects the response of the muscles to repair the damage suffered. When you exercise, micro-injuries are created that the body heals naturally, thus becoming more muscular.

A recommendation from the American College of Sports Medicine (ACSM) to prevent muscle pain is to move slowly when starting a new training, offering time for the body to adapt and recover. In other words, don’t start at the gym with the most significant weight.

Triceps Injury Symptoms

Because of the tendon’s inflammation, the patient cannot even perform arm extension movements and muscle stiffness, and it is possible to notice minor edema near the elbow region.

Stiffness occurs due to inflammation of the tendon, which is very mobile, and when it is inflamed, it does not have the flexibility to perform the movements that the body requires.

Triceps pain due to Myofascial Pain Syndrome

Triceps myofascial pain is a condition characterized by pain and/or autonomic phenomena that are referred from active trigger points in the triceps muscle, accompanied by associated dysfunction (Graff‐Radford, 2001). This form of myofascial pain is a type of soft-tissue rheumatism resulting from irritable foci, or trigger points, within the skeletal muscles and their ligamentous junctions, which can restrict the full range of motion and refer pain centrifugally when stimulated (Bennett, 2007).

Myofascial pain syndrome (MPS) in the triceps muscle often arises from acute and chronic musculoskeletal pain, with origins between the motor end plate and the fibrous outer covering of the muscle. It often includes a referred neuropathic component, which can contribute to the complexity of the pain experienced (Weller et al., 2018).

The pain is typically localized to the triceps muscle and can be referred to areas such as the shoulder and the ulnar aspect of the arm and forearm. This referred pain is a hallmark of myofascial pain syndromes and results from the activation of trigger points (TrPs) in the muscle. These TrPs are specific regions within the muscle where local and remote pain can be evoked by palpation and are considered the primary cause of MPS (Simons, 1991).

Treatment of triceps myofascial pain typically aims to inactivate these trigger points and restore normal muscle relationships. This can involve various therapies, including physical therapy, massage, and in some cases, medication to manage pain and inflammation (Gerwin, 1997).

Triceps pain: diagnosis

One of the most valuable and used methods to initiate the diagnosis of a patient with triceps tendonitis involves the person’s medical history and physical examination.

Going further, it is possible to use radiography, which shows the region’s details that, in this case, may present a spur on one of the bones of the arm[2]Hackel J, Tabacco J. Diagnostic ultrasound of the elbow. Applied Radiology. 2014 Dec 1;43(12):9-16..

And to conclude, doing an MRI may also be recommended, which helps confirm the diagnosis.

Triceps Injury Treatment Options

The treatment for triceps tendonitis undergoes a clinical evaluation that aims to assess the conditions presented by the patient and rule out conditions such as lateral epicondylitis, for example.

After diagnosis, treatment goes through the conservative style, with the application of ice in its initial stage. With the accompaniment of an orthopedist, anti-inflammatory drugs are part of the recovery and the physiotherapy complement, which consists of strengthening the patient’s muscles and tendon so that they return to their physical activities or daily life again.

Non Pharmacological Treatments

Non-pharmacological treatment options for triceps injuries include physical therapy, rest, and compression.

  1. Ultrasound-Guided Needle Barbotage and Lavage: This technique can be effective for chronic, calcific triceps tendinopathy, providing significant pain relief and functional improvement. It allows patients to resume activities like weight lifting without pain (Schaefer, Garcia & Rosa Padilla, 2017).
  2. Platelet-Rich Plasma (PRP) Injections: For partially torn triceps tendons, PRP injections can be an effective treatment. This is often combined with physical therapy, allowing patients to return to activities like light weight training after a rehabilitation period (Cheatham, Kolber, Salamh & Hanney, 2013).
  3. Arthroscopic Triceps Repair: In cases of triceps injuries that require surgical intervention, arthroscopic repair can be a safe and effective treatment. Post-surgery, physical therapy is crucial for recovery, typically enabling a return to sports within 4 months (Savoie, 2019).
  4. Stretching and Strengthening Exercises: Specific exercises designed to stretch and strengthen the triceps muscle can be beneficial. For instance, exercises targeting the triceps surae are used in managing conditions like plantar fasciitis, showing the versatility of stretching in physical therapy (Pontin, Costa & Chamlian, 2014).
  5. Rehabilitation Programs for Athletes: Specialized physical therapy rehabilitation programs can be critical in diagnosing and accelerating the return to competitive play for athletes, particularly in sports-related triceps injuries (Anloague & Strack, 2018).
  6. Motor Imagery: For patients with more severe conditions, such as quadriplegia following tendon transfer, motor imagery can be used to improve motor recovery. This technique helps in reducing hand trajectory variability and maintaining motor performance (Grangeon et al., 2010).
  7. Nonoperative Management: In cases where surgery is not indicated, nonoperative management including physical therapy can be effective. This approach often includes a combination of exercises, stretching, and sometimes, nonsteroidal anti-inflammatory drugs or muscle relaxants (Childress & Becker, 2016).

Physical Therapy for Triceps Pain

Physical therapy is a crucial component of triceps injury recovery, as it helps restore function and prevent future injuries. A physical therapist can design a rehabilitation program that includes stretching, strengthening, and range of motion exercises tailored to the individual’s needs. Some specific exercises and techniques used in physical therapy for triceps injuries may include gait training, weight shifting, eccentric calf lowering, balance practice, and lower extremity strengthening and stretching. 

Manual techniques, such as joint mobilizations and soft tissue mobilization, can also be employed to improve joint mobility and reduce pain.

Rest is essential for allowing the injured triceps to heal. It involves avoiding activities that cause pain or exacerbate the injury. The duration of rest required depends on the severity of the injury and the individual’s healing process.

Compression can help provide support and reduce swelling in the injured area. This can be achieved using a compression bandage or sleeve, which should be applied snugly but not too tight to avoid restricting blood flow. Compression can help manage inflammation and provide stability to the affected area during the healing process.

Pharmacological Treatments

Pharmacological treatment options for triceps injuries include nonsteroidal anti-inflammatory drugs (NSAIDs), analgesics, and opioids.NSAIDs, such as ibuprofen, are commonly used to reduce pain and inflammation in triceps injuries1

They work by inhibiting the production of prostaglandins, which are chemicals responsible for causing inflammation and pain. NSAIDs are generally well-tolerated but should be used with caution in individuals with a history of gastrointestinal issues or kidney problems.

Analgesics, such as acetaminophen, can help manage pain in triceps injuries without the anti-inflammatory effects of NSAIDs. Acetaminophen is generally considered safe when used as directed but should be used with caution in individuals with liver problems.

Opioids, such as codeine or oxycodone, are strong pain relievers that may be prescribed for severe triceps injuries when other pain management options are insufficient. However, opioids should be used with caution due to their potential for addiction and side effects. They are typically reserved for short-term use under close clinical supervision, and even in these cases, combination therapy with non-opioid pain relievers may be preferred.

It is essential to consult a healthcare professional for proper diagnosis and treatment recommendations tailored to your specific injury and needs.

Return to Activities

Treatment, when followed in a disciplined manner, can bring the patient to the sport in a short period. However, premature return to physical activity can cause a recurrence of the injury and even a worsening of the condition, such as tendon rupture.

However, patients should return to sports gradually and with the accompaniment and endorsement of the orthopedist since the cases of tendonitis may vary, and each patient may present different painful conditions. On the other hand, sports practice must be followed without excesses, with a gradual increase in intensity and rhythm.

Following recommendations to prevent tendinitis from developing in other body regions also prevents further injuries. Stretching before physical activity, not committing harmful excesses to the body, or even choosing shoes suitable for running, for example, are attitudes that prevent the return of discomfort in any joints.


Gabel, G. (1999). Acute and chronic tendinopathies at the elbow. Current Opinion in Rheumatology, 11(2), 138-143.

Bunshah, J. J., Raghuwanshi, S., Sharma, D., & Pandita, A. (2015). Triceps tendon rupture: An uncommon orthopaedic condition. BMJ Case Reports, 2015.

Weistroffer, J. K., Mills, W., & Shin, A. (2003). Recurrent rupture of the triceps tendon repaired with hamstring tendon autograft augmentation: A case report and repair technique. Journal of Shoulder and Elbow Surgery, 12(2), 193-196.

Vidal, A. F., & Allen, A. (2003). Biceps Tendon and Triceps Tendon Injuries. Sports Medicine and Arthroscopy Review, 11, 47-56.

Noto, J., Elangovan, C., & Bandyopadhyay, S. (2019). Kinetics And Fiber Distribution Of The Three Muscle Heads Of Triceps For a Better C7 Myotomal EMG Study (P1.4-034). Neurology, 92.

Naidu, S., Lim, A., Looi Kok Poh, V. P., & Kumar, V. P. (2007). Long Head of the Triceps Transfer for Elbow Flexion. Plastic and Reconstructive Surgery, 119, 45e-47e.

Vergara-Amador, E., & Vela-Rodríguez, F. (2016). [Transfer of the long head of triceps for elbow flexion in braquial plexus sequelae]. Acta Ortopedica Mexicana, 30(6), 326-328.

Akamatsu, F., Negrão, J. R., Rodrigues, M. B., Itezerote, A., Saleh, S., Hojaij, F., Andrade, M., & Jacomo, A. (2020). Is there something new regarding triceps brachii muscle insertion? 1. Acta Cirúrgica Brasileira, 35.

Madsen, M., Marx, R., Millett, P., Rodeo, S., Sperling, J., & Warren, R. (2006). Surgical Anatomy of the Triceps Brachii Tendon. The American Journal of Sports Medicine, 34, 1839-1843.

Graff‐Radford, S. (2001). Regional myofascial pain syndrome and headache: Principles of diagnosis and management. Current Pain and Headache Reports, 5, 376-381.

Bennett, R. (2007). Myofascial pain syndromes and their evaluation. Best Practice & Research. Clinical Rheumatology, 21(3), 427-445.

Weller, J. L., Comeau, D., & Otis, J. A. D. (2018). Myofascial Pain. Seminars in Neurology, 38, 640-643.

Simons, D. (1991). Symptomatology and clinical pathophysiology of myofascial pain. Der Schmerz, 5, S29-S37.

Gerwin, R. (1997). Myofascial pain syndromes in the upper extremity. Journal of Hand Therapy, 10(2), 130-136.

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MD, PhD. Physical Medicine & Rehabilitation Physician from São Paulo - Brazil. Pain Fellowship in University of São Paulo.


1Jafarnia K, Gabel GT, Morrey BF. Triceps tendinitis. Operative techniques in Sports Medicine. 2001 Oct 1;9(4):217-21.
2Hackel J, Tabacco J. Diagnostic ultrasound of the elbow. Applied Radiology. 2014 Dec 1;43(12):9-16.

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