Popeye sign
1. What is the “Popeye sign” most commonly associated with?
âś… The Popeye sign is a bulging of the biceps muscle belly due to rupture of the long head of the biceps tendon.
2. Which movement is primarily affected in a patient with Popeye sign?
âś… Elbow flexion and forearm supination are functions of the biceps, which are impaired in long head rupture.
3. The Popeye sign appears due to:
✅ Muscle belly retracts distally forming a bulge when the tendon ruptures proximally—called the Popeye sign.
4. In which demographic is Popeye sign most commonly seen?
âś… Chronic overuse and degenerative tendon wear in middle-aged males often leads to long head biceps rupture.
5. What imaging modality best confirms Popeye sign diagnosis?
âś… High-resolution ultrasound allows direct visualization of tendon rupture and muscle retraction.
6. Which biceps head is most often involved in Popeye sign?
âś… The long head runs intra-articularly through the shoulder, making it more vulnerable to rupture.
7. What is the typical treatment for Popeye sign in elderly patients with minimal symptoms?
âś… Conservative treatment is preferred in elderly individuals unless severe functional impairment exists.
8. Which of the following is least likely a risk factor for Popeye sign?
âś… Hypothyroidism is not a recognized risk factor for biceps tendon rupture, unlike overuse or steroids.
9. Which test can evaluate biceps tendon integrity clinically?
✅ Speed’s test assesses long head biceps tendon pathology and elicits anterior shoulder pain.
10. What complication may occur with chronic Popeye sign if left untreated?
âś… Chronic rupture may cause weakness, cramps, and visible deformity but not infection or necrosis.
11. What is the characteristic location of the muscle bulge in Popeye sign?
âś… The detached muscle belly retracts and bunches up in the anterior upper arm, producing the “Popeye” shape.
12. What is the most appropriate definitive treatment for athletes with Popeye sign and loss of supination strength?
âś… Tenodesis is often performed to restore function in high-demand individuals.
13. Popeye sign results from detachment at which anatomical site?
âś… The long head of biceps originates from the supraglenoid tubercle, where rupture leads to Popeye deformity.
14. Which physical activity is most likely to precipitate Popeye sign?
âś… Forceful eccentric contraction during lifting or pulling is a common cause of long head rupture.
15. What feature helps distinguish between complete and partial tendon rupture?
âś… In complete rupture, the tendon retracts, whereas partial tear may preserve muscle contour.
16. Popeye sign may be mistaken for which of the following?
âś… The soft-tissue bulge may mimic a hematoma or muscle hernia without proper clinical context.
17. Which other tendon pathology is often associated with Popeye sign?
âś… Biceps long head tears often co-exist with rotator cuff pathology due to shared wear patterns.
18. Surgical reattachment of the biceps tendon is called:
âś… Biceps tenodesis involves anchoring the tendon to the humerus to restore contour and strength.
19. Which symptom may alert a clinician to look for Popeye sign?
âś… Patients often report a “pop” or snap followed by bulge and weakness in the arm.
20. Which of the following is a classic clinical finding in Popeye sign?
âś… The Popeye deformity is visibly asymmetric and occurs only on the side with tendon rupture.
🔍 Click to View: 20 Advanced Clinical Points on the Popeye Sign
| # | Clinical Insight |
|---|---|
| 1 | Popeye sign indicates rupture of the long head of the biceps tendon. |
| 2 | It presents as a visible bulge in the anterior upper arm, especially when flexed. |
| 3 | Most common in middle-aged males and individuals doing repetitive overhead work. |
| 4 | Usually caused by chronic degenerative changes or acute trauma. |
| 5 | The tendon typically ruptures near the supraglenoid tubercle of the scapula. |
| 6 | Patients often report a sudden “pop” sound or snapping sensation. |
| 7 | Conservative treatment is appropriate for elderly or low-demand individuals. |
| 8 | Biceps tenodesis is a surgical option for young or athletic individuals. |
| 9 | Ultrasound or MRI confirms the diagnosis and evaluates the degree of retraction. |
| 10 | Weakness is more pronounced in supination than in flexion due to loss of tendon function. |
| 11 | Speed’s test may reproduce pain and assess the integrity of the long head tendon. |
| 12 | May be associated with rotator cuff pathology in older patients. |
| 13 | Distal biceps tendon rupture is a separate entity and presents differently. |
| 14 | Repetitive microtrauma and steroid injections can predispose to rupture. |
| 15 | The cosmetic deformity is often more concerning than the functional loss. |
| 16 | Popeye sign is usually unilateral; bilateral cases are rare. |
| 17 | Differential diagnoses include hematoma, lipoma, or muscle herniation. |
| 18 | Tenotomy may be considered in low-demand individuals preferring simple release. |
| 19 | Most patients regain adequate function with proper rehabilitation post-injury or surgery. |
| 20 | Prompt diagnosis improves management decisions and patient satisfaction. |
 Popeye sign, also known as Popeye deformity, describes a noticeable bulge or swelling in the upper arm, particularly prominent when the elbow is flexed. This visual cue is a classic sign of a complete tear of the long head of the biceps tendon
