What is Causing Your Triceps Pain?
What is triceps pain?
The triceps is the large muscle on the back of your upper arm that lets you straighten and extend your arm at the elbow. It is called the triceps because it’s made up of three parts (called muscle bellies).
Pain or discomfort in the triceps can have a number of causes, but often means you have tears of the muscle fibers. They can be microtears, causing soreness, or larger tears, causing strains.
You may also get triceps tendonitis and tendinopathy. The tendon is the cord-like structure that connects the triceps muscle to the bone at the elbow. Tendonitis is inflammation and pain of this tendon, which happens with repetitive motion against resistance. Tendinopathy is a chronic condition that eventually damages the tendon. The tendon can also rupture, a more serious and painful triceps tendon injury.
1. Overuse or overexertion
It is most important to describe the exact timing, severity, and location of the pain, and any changes to those factors. These are extremely helpful in pinpointing the exact problem and determining what (if any) treatment is necessary. —Dr. Mike Gaspar
- Dull achy pain over the entire triceps muscle
- Both contracting the muscle (straightening the arm) and relaxing the muscle (bending the arm) may worsen the feeling of soreness.
- Soreness may take 1 to 2 days to set in after you overexerted it and usually lasts just a few days.
Triceps soreness is caused by microtears in the muscle fibers. It can happen after working out or an activity like shoveling or a night of axe-throwing. This is a normal part of the healing process after a muscle is worked hard. You typically don't feel sore until the next day or two.
Because the soreness generally goes away on its own, you just need to rest, do light stretching, and light massage.
2. Triceps strain
- Sudden pain during strenuous or forceful activity
- Pain may be accompanied by a “tearing or ripping” sensation in the muscle
- Pain worsens when extending the arm, particularly against resistance
A triceps strain is when the muscle tears, causing sudden and sharp pain. How painful it is depends on how many muscle fibers are torn.
Treatment should include rest initially along with icing. When the pain is tolerable, light movement and stretching will help avoid stiffness. If pain is extreme and intolerable or lasts more than 1 to 2 weeks after the injury, you should call your doctor.
3. Tendonitis and tendinopathy
People often think that an injury to the triceps is within the “meat” of the muscle. While this is sometimes true, the majority of injuries to the triceps is to the triceps tendon—the part where the tendon meets the muscle, called the musculotendinous junction. —Dr. Gaspar
- Pain and tenderness at the back of the elbow that may come and go, and is usually worse with activity that involves straightening the arm.
- Weakness when straightening the arm
Tendonitis is an inflammation of the tendon, the cord that connects the triceps to the bone at the elbow. It occurs after repetitive movement at the elbow that causes microtears in the tendon. However, because tendon does not have the ability to heal itself well, over time tendonitis may develop into tendinopathy, which is a chronic degeneration of the tendon.
For both tendonitis and tendinopathy, pain will get worse with movements that require you to straighten your arm, particularly against resistance, such as doing push-ups. Triceps tendonitis can be treated by rest, ice, compression, and light stretching. Anti-inflammatory medications, like ibuprofen or naproxen, may also help with the pain.
Because tendinopathy is a degenerative condition rather than inflammatory, these medications may not be effective, and heating the area with heat-packs is more likely to help than icing.
4. Tendon rupture
- Sudden pain at the back of the elbow, often with a “popping” sound or sensation
- You may feel a “gap” if you press just above the back of the elbow where the tendon should meet the bone.
- Weakness or inability to straighten the arm
- Bruising near the back of the elbow
A tendon rupture is a large tear of the tendon that you can see with the naked eye. The rupture can be partial, meaning that some of the tendon is still attaching the triceps muscle to the bone. A full rupture is a complete tear where the triceps muscle is completely detached from the bone at the elbow.
Triceps tendon ruptures often occur when the tendon has already been weakened. This may be because of chronic tendinopathy. In addition, underlying medical conditions may weaken the tendon leading to rupture, including chronic steroid use, endocrine disorders, local steroid injections, or prior elbow surgery.
Treatment for full ruptures usually involves surgery to repair the tendon, while partial ruptures may or may not require surgery depending on pain and function. If you believe you have either a partial or full triceps tendon rupture, see a doctor within a few days.
- Visible bruise on the back of the upper arm
- Pain or tenderness at bruise site
Bruising of the triceps muscle typically occurs from direct impact, such as being punched in the back of the arm or bumping into a door.
In high impact trauma, such as car accidents or being hit with a baseball bat, bruising may be a sign of a fracture of the humerus (the upper arm bone). The pain will be severe, and any attempts to move your arm will be even more painful. There may also be a visible deformity. If you suspect that your arm is broken, you should go to the ER immediately.
Other possible causes of triceps pain
Because pain of the triceps tendon generally occurs at the elbow, it may be difficult to distinguish triceps tendonitis or tendon injury from a number of other causes of elbow pain. However, it should not be assumed that pain at the elbow is unrelated to the triceps. —Dr. Gaspar
A number of conditions may also cause triceps pain, but they may be uncommon or triceps pain may not be a hallmark symptom:
- Radial nerve injury
- Cervical spine or brachial plexus injury
- Cellulitis (local skin and soft tissue infection)
- Compartment syndrome of the upper arm
When to call the doctor
- If your triceps pain does not get better in 1 to 2 weeks with at-home treatment or interferes with daily activities.
- Pain is getting worse with time
- If you experience pain in both the neck and the back of the upper arm
- If you feel gradual-onset tingling, numbness, or weakness in the arm.
Should I go to the ER for triceps pain?
You should go to the ER with triceps pain if you have the following symptoms:
- You notice a dent along with serious pain around your elbow. This may be tendon damage from a fall on an outstretched hand.
- You have a spreading rash on your skin that is warm to the touch, especially if you have fevers.
- You have sudden-onset arm pain or tingling. This may be a sign that you injured the spinal cord from a herniated disc or other abnormality in the neck.
- Try RICE (Rest, Ice, Compression, and Elevation) for pain when you have a sudden injury or overuse injury. Rest and ice the arm and apply mild compression, such as with an ace bandage. Try to elevate the arm to prevent or reduce inflammation, particularly after activity.
- Pain medications. NSAIDs such as ibuprofen (Advil, Motrin) can help with pain and swelling. Make sure to follow the directions on the bottle and do not take the medication for more than a week without seeing a doctor.
- Professional training. If you experience triceps pain or soreness during a sport, for example, tennis, work with a pro to adjust your technique. Likewise, if you develop soreness or pain from working out, see a personal trainer or fitness professional to learn how to strengthen the muscle to prevent pain. Avoid drastic increases in weights and jerky or uncontrolled movements when weightlifting.
- Home exercises. A trainer or physical therapist may be able to show you some exercises and stretches that can be performed at home with minimal equipment. These can strengthen the muscle and tendon and help prevent further injury.
- Use heat. A heating pad can help relieve the pain of chronic tendinopathy.
Other treatment options
Your medical provider may prescribe one or more of the following treatments, depending on the cause of your triceps pain.
- Physical therapy. This can help strengthen the triceps muscle and tendon.
- Pain medications. For severe pain, these can help but their use should be closely monitored by a medical professional.
- Surgery. You may need a referral for surgical management if you have a rupture of the triceps tendon.
Dr. Gaspar is an orthopaedic surgeon-scientist with a subspecialty focus on upper extremity surgery. He graduated from the Cornell University (2006) with a B.S. in Biological Engineering before obtaining his medical degree from the Medical College of Virginia (2010). After completing his surgical internship at Loyola University Medical Center-Chicago (2011), Dr. Gaspar underwent further surgical training as an orthopaedic surgery resident at Albany Medical Center (2015), followed by an academic fellowship in hand and upper extremity surgery at Thomas Jefferson University’s Philadelphia Hand to Shoulder Center (PHSC), where he subsequently spent more than 5 years as the Director of Clinical Research and Undergraduate Medical Education. During that time, he also completed an executive M.B.A. from the University of Virginia’s Darden School of Business (2019).
Dr. Gaspar has been awarded several research fellowships at institutions including PHSC, the Hand Rehabilitation Foundation, Anderson Orthopaedic Clinic and Hospital for Special Surgery, and has received funding from the NIH, NSF and Arthritis Foundation, as well as from industry. He has published over 50 peer-reviewed journal articles and book chapters, and has served as an ad hoc reviewer for 20 international medical journals. He was honored as a “Top Doctor Under 40” by the Pennsylvania State Medical Society in 2018 and named to their Opioid Task Force in 2020. He has also served as a consultant and advisor to the Philadelphia Eagles and the NFL Players Association.