Snapping Triceps Syndrome

Snapping triceps syndrome is an uncommon cause of elbow pain that can present in association with ulnar nerve symptoms or as an isolated problem
It can also be seen following a previous ulnar nerve decompression/transposition with persistent medial elbow “popping” and discomfort
Patients present with a variety of symptoms including cubital tunnel syndrome, ulnar nerve subluxation, or prominent medial elbow snapping
Frequently there will be two snaps with the ulnar nerve subluxation at 70-90 degrees of flexion and the triceps snapping at 115-120 degrees of flexion
Snapping triceps is a clinical diagnosis but dynamic ultrasound can help confirm the diagnosis
Treatment for symptomatic snapping triceps is typically surgical with ulnar nerve transposition and addressing the medial head of the triceps
The medial head of the triceps can be excised or transposed to achieve stability

18 y/o high school baseball player presents with snapping and popping along the medial elbow
He reports frequent numbness, tingling and elbow discomfort related to throwing
Intraoperative findings demonstrate subluxation of the ulnar nerve with a prominent “snap” of the medial head of the triceps with deep flexion
Following ulnar nerve transposition, the medial head of the triceps is transposed and woven through the main triceps tendon to achieve stability

Clinical exam demonstrates prominent snap across the medial elbow

Ulnar nerve easily subluxes with elbow flexion

Ulnar nerve subluxes followed by the medial triceps tendon snapping over the medial epicondyle

Prominent medial triceps tendon snaps over medial epicondyle

Ulnar nerve is transposed anteriorly and medial triceps fascia is transferred to the main triceps tendon

21 y/o collegiate softball player previously underwent ulnar nerve transposition secondary to ulnar nerve subluxation
Following surgery she reports ongoing “popping” along the medial elbow that results in pain and discomfort. She denies any residual numbness or tingling
On clinical exam the medial head of the triceps is felt to snap with deep elbow flexion
The medial head of the triceps is released and transposed to the central tendon to achieve stability

Medial head of the triceps snaps over the medial epicondyle following previously transposed ulnar nerve

Snapping portion of the medial triceps is released and woven within the main tendon. Previously transposed ulnar nerve can be seen anteriorly