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A 56-year-old man’s left arm shows an obvious deformity, known as a “Popeye deformity.” The man’s right bicep, which was unaffected, is shown for comparison.
A 56-year-old man presents with a left arm deformity after a fall 2 days previously. He believes it developed after he fell backward, landing on his extended arm. Shortly after the injury, he noticed pain and an obvious deformity in his left bicep muscle. Images of the normal right bicep muscle and abnormal left bicep muscle are shown.
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The patient presents with an obvious deformity to the left arm or a “Popeye deformity.” A tear of the proximal biceps, or the long head of the biceps brachii, causes the muscle belly to bunch distally, resulting in this deformity. The long head of the biceps brachii tendon originates from the superior aspect of the glenoid labrum. The proximal biceps exits the shoulder joint through the bicipital groove located between the greater and lesser tuberosity of the humeral head. The long head joins the short head at its insertion site distally at the radial tuberosity. The role of the biceps brachii is thought to be as a depressor of the humeral head and an anterior joint stabilizer.1
It is important to educate patients that they will likely not notice any functional loss or weakness as a result of the injury because the short head of the biceps remains attached to the coracoid. The deformity caused by the distal bunching of the biceps muscle will not go away, however.
Conservative treatment is recommended in most cases as relief of pain is expected in 4 to 6 weeks if no other pathology is present. Surgery may be indicated if it is needed for other injury, such as associated labral and rotator cuff tears; however, the only clear benefit of surgical treatment for a Popeye deformity is cosmesis. Those who perform highly physical labor may experience some cramping or aching in the muscle, and a procedure to reattach the tendon to the bone (biceps tenodesis) may be beneficial. Patients may experience a small (7%-10%) increase in flexion strength with surgery as well.2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
References
- Nho SJ, Strauss EJ, Lenart BA, et al. Long head of the biceps tendinopathy: diagnosis and management. J Am Acad Orthop Surg. 2010;18(11):645-656.
- Wheeless CR III. Proximal Biceps Tendon Rupture. In: Wheeless CR III, Nunley JA II, Urbaniak JR, eds. Wheeless’ Textbook of Orthopaedics. http://www.wheelessonline.com/ortho/proximal_biceps_tendon_rupture. Updated November 20, 2012. Accessed March 14, 2016.
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