Structual Abnormalities and Snapping Triceps Syndrome

And the saga continues.. The e-book has been released, but the show must go on. What if I were to tell you that snapping triceps syndrome is something you were born with? It’s something that I hate to say, but it very well may be true. Shocking, isn’t it? Hell, I can feel the nuclear explosion that just occurred inside your skull.

Morpheus meme.

Our “Divine Creator” F***ed Up. Someone Tell Him He Designed Some of Our Elbows Incorrectly.

I’ve stated ad nauseam that ulnar nerve subluxation is a potentially prevalent ailment in our population (Childress HM) (Okamoto M, et. al). It got me wondering – if that condition is so prevalent, how common is snapping triceps syndrome? Anecdotally, quite a few people have experienced it (seriously, just Google the condition and see what people say on fitness-related forums).

Interestingly enough, a study I found examined 15 patients who have undergone ulnar nerve transposition surgery to fix their ulnar nerve subluxation – yet, they still experienced snapping and pain in their elbows. Upon further investigation, the doctors discovered that these patients all had snapping triceps syndrome – the similar yet anatomically different “snapping” condition. It’s even suggested that snapping triceps syndrome can further affect the ulnar nerve, even after nerve transposition surgery (Spinner RJ, et. al).

Unfortunately, this doesn’t give us hard data regarding the prevalence of snapping triceps, but it seems to coincide with the anecdotal evidence of patients discussing online how their surgery seemed to have failed. Like I said before, Google it, or even check out the comments on my original snapping triceps article.

On to the next study… of 17 patients getting surgery for ulnar nerve subluxation, 6 had snapping triceps syndrome. In a painfully small study size, that gives us a 35% occurrence co-existing with an already common condition – but that’s not what interested me at all about this study. The doctors also pointed out that 11 patients had structural abnormalities – 5 being enlarged medial triceps heads which contributed to their snapping triceps, 2 being abnormal insertions of the medial triceps tendon, and 1 being a presence of a fourth triceps tendon. (Richard JM, et. al)

Enlarged muscles, irregular tendon insertions, extra tendons… WHAT?! WHO DESIGNED OUR BODIES TO BE LIKE THIS?!?!

This is a bit disconcerting, because structural abnormalities can typically only be corrected through surgery.

A Few Questions Remain.

Given how common these conditions seem, combined with the fact that they are asymptomatic at times (Childress), could it be that ulnar nerve subluxation and snapping triceps syndrome are genetic anomalies that are insignificant to the human population? Some live with full-blown pain and weakness, some people feel nothing, and some feel minor discomfort. For most folks, it seems as if life goes on just fine, despite their conditions.

Also, because there appears to be a “spectrum” of severity for those with these two conditions, could there be a way to reduce this severity so that victims of these ailments can return to nearly painless movement again? If snapping triceps and ulnar nerve subluxation were a result solely of structural abnormalities and/or damage, surgery may be the only option to fix the problem – but, if it were to also result from passive reasons such as tissue quality, then there would exist a chance to treat it conservatively, just as I’ve discussed in my Snapping Elbows E-Book.

A Final, Unrelated Observation.

As some of you might know, I’ve successfully treated my ulnar nerve subluxation to the point of being able to perform pushups and presses with the full-ROM. I slacked off my treatment protocol and focused purely on lifting, and some snapping returned, albeit in a different manner. There was no signs of nerve irritation or numbness – everything has been localized to the elbow, and it has been quite painless this time around. The nerve snapped before, and now it;s the triceps that snaps. Now that I think of it, my case may have been a result of snapping triceps in the beginning after all.

Anyway, I found that, unlike what I experienced with ulnar nerve subluxation, simple movement or light-to-moderate loads do not provoke snapping, even within full-ROM. To illustrate: overhead triceps extensions with a light dumbbell causes nothing and chest-to-floor pushups cause a light snapping sensation, while one-arm pushup negatives – the best I can do – result in an extreme snap that feels like my medial triceps is going to rip out of my arm. I’m afraid of what damage can be done by these “max-effort” attempts.

It appears that, in my case, the severity of snapping triceps syndrome is load-dependent. Heavier load = heavier snapping.  One possible hypothesis is that the medial triceps can activate enough to maintain the tension necessary only with light-enough loads – heavier loads may result the medial triceps to “fail” in a sense, allowing it to go lax and slide over the medial epicondyle and then snap back into position.

Oddly enough, there is evidence that does NOT support my hypothesis, as it’s been seen that muscle activation in the medial triceps head is the same between those WITH snapping triceps and those WITHOUT it (Boon AJ, et. al). This observation doesn’t totally discount the possibility of a “passive” cause to these conditions, versus a structural anomaly.

Fortunately, concentric movements don’t seem to be an issue with these conditions. Knocking out your opponent’s teeth may become the best alternative to bench pressing as a “vertical pushing” exercise for those with affected elbows.

Pacquiao gifYour elbow doesn’t feel as bad as Pacquiao’s face, you cry-baby

References:

1. Childress HM. “Recurrent ulnar-nerve dislocation at the elbow.” Clinical Orthopaedics and Related Research. 108 (1975): 168-173. Web.

2. Okamoto M, et. al. “Morphology and dynamics of the ulnar nerve in the cubital tunnel. Observation by ultrasonography.” Journal of Hand Surgery. 25.1 (2000): 85-89. Web.

3. Spinner RJ, et. al. “Unrecognized dislocation of the medial portion of the triceps: another cause of failed ulnar nerve transposition.” Journal of Neurosurgery. 92.1 (2000): 92-97. Web.

4. Richard JM, et. al. “Management of Subluxating Ulnar Nerve at the Elbow.” Healio Orthopedics. 33.9 (2010). Web.

5. Boon AJ, et. al. “Muscle activation patterns in snapping triceps syndrome.”  Archives of Physical Medicine and Rehabilitation. 88.2 (2007): 239-242. Web.

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2 Comments

  1. Some people may be more predisposed to getting snapping triceps syndrome but certainly not its not something we are born with. I injured my elbow several times and i believe the inflammation and scar tissue may have distorted the anatomy resulting in snapping.

    • If you think about – how many children complain about snapping in their elbow? These structural abnormalities may very well be a result of damage, scar tissue, adhesions, etc, instead of it just being something one is born with. However, the possibility of the latter is still worth pondering.

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