Snapping triceps syndrome: a review of the literature and proposed operative treatment algorithm.

Background: The purpose of this study is to conduct a review of the literature on snapping triceps syndrome and to provide an overview on the epidemiology, mechanism, clinical presentation, diagnostic techniques, and treatments of this condition. In addition, we evaluate available evidence base of the current treatments so to recommend appropriate operative techniques in snapping triceps syndrome. Methods: Clinical studies were searched in 5 databases for "snapping triceps" and other similar key search terms. A total of 24 relevant studies were identified. From these we extracted information about number and demographics of patients, presenting symptoms, treatments, and outcomes. Results: A total of 64 patients were recorded. 90.6% (58/64) of the patients had coexisting instability of the ulnar nerve and 64.1% (41/64) had concomitant symptoms of ulnar neuropathy. Surgeries were performed in 67.2% (43/64) of the patients. The snapping triceps was unrecognized during the index surgery of the elbow in as high as 44.2% (19/43) of the operated patients. An operative treatment algorithm was proposed for snapping triceps syndrome. Conclusion: Snapping triceps syndrome is a rare orthopedic condition but often misdiagnosed. The treatments are determined by the severity of presenting symptoms and the conditions which alter the triceps angle. In patients treated with surgery, it is crucial to make sure full resolution of the snapping by examining all dislocating structures during passive elbow motion and/or myoelectrical stimulation. Excellent results of surgery can be achieved with meticulous evaluation.