Skip to main content

Advertisement

SpringerLink
Log in

Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh® models of the anatomic findings

  • Scientific Article
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

A Correction to this article was published on 04 April 2020

This article has been updated

Abstract

Objectives

Assess the insertional anatomy of the distal aspect of the triceps brachii muscle using magnetic resonance imaging (MRI) in cadavers with histologic correlation and Play-doh® models of the anatomic findings.

Materials

Elbows were obtained from twelve cadaveric arm specimens by transverse sectioning through the proximal portion of the humerus and the midportion of the radius and ulna. MRI was performed in all elbows. Two of the elbow specimens were then dissected while ten were studied histologically. Subsequently, Play-doh® models of the anatomic findings of the distal attachment sites of the triceps brachii muscle were prepared.

Results

MRI showed a dual partitioned appearance of the distal attachment sites into the olecranon in all specimens. In the deeper tissue planes, the medial head muscle insertion was clearly identified while superficially, the terminal portion of the long and lateral heads appeared as a conjoined tendon. Histologic analysis, however, showed continuous tissue rather than separate structures attaching to the olecranon.

Conclusion

Although MRI appeared to reveal separate and distinct attachments of the triceps brachii muscle into the olecranon, histologic analysis delineated complex but continuous tissue related to the attachments of the three heads of this muscle. The Play-doh® models were helpful for the comprehension of this complex anatomy and might serve as a valuable educational tool when applied to the analysis of other musculoskeletal regions.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13

Similar content being viewed by others

Change history

  • 04 April 2020

    Figures 9, 10, 11, 12 and 15 corrected.

References

  1. Tiger E, Mayer DP, Glazer R. Complete avulsion of the triceps tendon: MRI diagnosis. Comput Med Imaging Graph. 1993;17(1):51–4.

    Article  CAS  PubMed  Google Scholar 

  2. Jacobson JA, Jebson PJ, Jeffers AW, Fessell DP, Hayes CW. Ulnar nerve dislocation and snapping triceps syndrome: diagnosis with dynamic sonography--report of three cases. Radiology. 2001;220(3):601–5.

    Article  CAS  PubMed  Google Scholar 

  3. Kijowski R, Tuite M, Sanford M. Magnetic resonance imaging of the elbow. Part I: normal anatomy, imaging technique, and osseous abnormalities. Skelet Radiol. 2004;33(12):685–97.

    Article  Google Scholar 

  4. Resnick DLKH, Pretterlieber M. Internal derangements of joints. 2nd ed. Philadelphia: Saunders; 2007.

    Google Scholar 

  5. Chung CB. Elbow tendons and epicondylitis. In: Chung CBSL, editor. MRI of the upper extremity: shoulder, elbow, wrist, and hand. Philadelphia: Lippincott Willians & Wilkins; 2010. p. 431–61.

    Google Scholar 

  6. Hayter CL, Adler RS. Injuries of the elbow and the current treatment of tendon disease. AJR Am J Roentgenol. 2012;199(3):546–57.

    Article  PubMed  Google Scholar 

  7. Kholinne E, Al-Ramadhan H, Bahkley AM, Alalwan MQ, Jeon IH. MRI overestimates the full-thickness tear of distal triceps tendon rupture. J Orthop Surg (Hong Kong). 2018;26(2):2309499018778364.

    Article  Google Scholar 

  8. Downey R, Jacobson JA, Fessell DP, Tran N, Morag Y, Kim SM. Sonography of partial-thickness tears of the distal triceps brachii tendon. J Ultrasound Med. 2011;30(10):1351–6.

    Article  PubMed  Google Scholar 

  9. Kaempffe FA, Lerner RM. Ultrasound diagnosis of triceps tendon rupture. A report of 2 cases. Clin Orthop Relat Res. 1996;332:138–42.

    Article  Google Scholar 

  10. Konin GP, Nazarian LN, Walz DM. US of the elbow: indications, technique, normal anatomy, and pathologic conditions. Radiographics. 2013;33(4):E125–47.

    Article  PubMed  Google Scholar 

  11. Belentani C, Pastore D, Wangwinyuvirat M, Dirim B, Trudell DJ, Haghighi P, et al. Triceps brachii tendon: anatomic-MR imaging study in cadavers with histologic correlation. Skelet Radiol. 2009;38(2):171–5.

    Article  Google Scholar 

  12. Keener JD, Chafik D, Kim HM, Galatz LM, Yamaguchi K. Insertional anatomy of the triceps brachii tendon. J Shoulder Elb Surg. 2010;19(3):399–405.

    Article  Google Scholar 

  13. Keener JD, Sethi PM. Distal triceps tendon injuries. Hand Clin. 2015;31(4):641–50.

    Article  PubMed  Google Scholar 

  14. Madsen M, Marx RG, Millett PJ, Rodeo SA, Sperling JW, Warren RF. Surgical anatomy of the triceps brachii tendon: anatomical study and clinical correlation. Am J Sports Med. 2006;34(11):1839–43.

    Article  PubMed  Google Scholar 

  15. Barco R, Sanchez P, Morrey ME, Morrey BF, Sanchez-Sotelo J. The distal triceps tendon insertional anatomy-implications for surgery. JSES Open Access. 2017;1(2):98–103.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Prokopis PM, Weiland AJ. The triceps-preserving approach for semiconstrained total elbow arthroplasty. J Shoulder Elb Surg. 2008;17(3):454–8.

    Article  Google Scholar 

  17. Khiami F, Tavassoli S, De Ridder BL, Catonne Y, Sariali E. Distal partial ruptures of triceps brachii tendon in an athlete. Orthop Traumatol Surg Res. 2012;98(2):242–6.

    Article  CAS  PubMed  Google Scholar 

  18. Tagliafico A, Gandolfo N, Michaud J, Perez MM, Palmieri F, Martinoli C. Ultrasound demonstration of distal triceps tendon tears. Eur J Radiol. 2012;81(6):1207–10.

    Article  PubMed  Google Scholar 

  19. Celli A. Triceps tendon rupture: the knowledge acquired from the anatomy to the surgical repair. Musculoskelet Surg. 2015;99(Suppl 1):S57–66.

    Article  PubMed  Google Scholar 

  20. Athwal GS, McGill RJ, Rispoli DM. Isolated avulsion of the medial head of the triceps tendon: an anatomic study and arthroscopic repair in 2 cases. Arthroscopy. 2009;25(9):983–8.

    Article  PubMed  Google Scholar 

  21. Windisch G, Tesch NP, Grechenig W, Peicha G. The triceps brachii muscle and its insertion on the olecranon. Med Sci Monit. 2006;12(8):BR290–4.

    PubMed  Google Scholar 

  22. Giannicola GBG, Sacchetti FM, Polimanti D, Scacchi M. Triceps ruptures. The Elbow. Switzerland: Springer International Publishing AG; 2018.

    Google Scholar 

  23. Bodor B (n.d.) Distal triceps injuries 2010 Available from: radsource.us/biographies/daniel-bordor-m-d.

  24. Thomas JR, Lawton JN. Biceps and triceps ruptures in athletes. Hand Clin. 2017;33(1):35–46.

    Article  PubMed  Google Scholar 

  25. Demirhan M, Ersen A. Distal triceps ruptures. EFORT Open Rev. 2016;1(6):255–9.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Tagliafico AS, Bignotti B, Martinoli C. Elbow US: anatomy, variants, and scanning technique. Radiology. 2015;275(3):636–50.

    Article  PubMed  Google Scholar 

  27. Agius MB MR, Jazayeri FR, Miller CV, Webber SM. The creation of Playdoh models as an educational tool for teaching anatomy of the eyelid. PMFA J. 2019;6(2).

  28. Herur A, Kolagi S, Chinagudi S, Manjula R, Patil S. Active learning by play dough modeling in the medical profession. Adv Physiol Educ. 2011;35(2):241–3.

    Article  PubMed  Google Scholar 

  29. Eftekhar B, Ghodsi M, Ketabchi E, Ghazvini AR. Play dough as an educational tool for visualization of complicated cerebral aneurysm anatomy. BMC Med Educ. 2005;5(1):15.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Beazley JC, Lawrence TM, Drew SJ, Modi CS. Distal biceps and triceps injuries. Open Orthop J. 2017;11:1364–72.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Bianchi S MC. Ultrasound of musculoskeletal system: Springer; 2007.

Download references

Author information

Author notes

  1. José Renato Negrão

    Present address: University of Sao Paulo Medical School, 450 Tito Street, Vila Romana, São Paulo, São Paulo, 05051-000, Brazil

Authors and Affiliations

  1. Radiology Department, Musculoskeletal Division, VA Healthcare System, University of California San Diego, San Diego, 3350, La Jolla Village Drive, San Diego, 92161, CA, USA

    José Renato Negrão, Roberto Mogami, Francisco Alejandro Ramirez Ruiz, Felipe Victora Wagner, Parviz Haghighi & Donald L. Resnick

  2. Radiology Department of Hospital Universitário Pedro Ernesto, State University of Rio de Janeiro, Av 28 de setembro 77, Rio de Janeiro, 20551-030, RJ, Brazil

    Roberto Mogami

  3. Division of Musculoskeletal Radiology, Clinica Felippe Mattoso Américas - Fleury, Av. das Américas 4303, Rio de Janeiro, 22640-903, RJ, Brazil

    Roberto Mogami

  4. Radiology Department, Pablo Tobon Uribe Hospital, Medellin, Colombia

    Francisco Alejandro Ramirez Ruiz

  5. Moinhos de Vento Hospital, Porto Alegre, Rio Grande do Sul, Brazil

    Felipe Victora Wagner

  6. Department of Pathology, VA Healthcare System San Diego, University of California San Diego, San Diego, CA, USA

    Parviz Haghighi

  7. Orthopedic Surgery, Radiology University of California San Diego, San Diego, CA, USA

    Samuel R. Ward

Authors
  1. José Renato Negrão
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Roberto Mogami
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Francisco Alejandro Ramirez Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felipe Victora Wagner
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Parviz Haghighi
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Samuel R. Ward
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Donald L. Resnick
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to José Renato Negrão.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Negrão, J.R., Mogami, R., Ramirez Ruiz, F.A. et al. Distal insertional anatomy of the triceps brachii muscle: MRI assessment in cadaveric specimens employing histologic correlation and Play-doh® models of the anatomic findings. Skeletal Radiol 49, 1057–1067 (2020). https://doi.org/10.1007/s00256-020-03382-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-020-03382-3

Keywords

Search

Navigation