When a tendon in your biceps muscle tears, the muscle can bunch up and form a large, painful ball on your upper arm. This bulge is called a Popeye deformity or Popeye sign. It’s named after the ball-shaped biceps of a popular cartoon character of the 1930s.
Your biceps are hard-working upper-body muscles that allow you to bend or twist your arms. Tendons connect the biceps to the shoulder joint (the proximal end) and to your elbow and lower arm (the distal end).
Tendons often become frayed from wear before they tear. But the tear usually occurs suddenly, with no warning.
Popeye deformity is most often found in people over 50 but can occur at any age. In 96 percent of cases, the tear is in the tendon that connects to the shoulder joint.
Popeye deformity is often treated conservatively, but sometimes surgery may be used to repair the tendon.
The symptoms of Popeye deformity depend on the extent of the tear.
Symptoms may include:
- hearing or feeling a pop when the tendon breaks away from the bone
- a sudden, sharp pain in your arm
- bruising, soreness, or tenderness in your upper arm
- weakness in your shoulder and elbow
- cramping in your biceps muscle when you’re doing something strenuous
- difficulty turning your arm so that your palm faces up or down
- fatigue when doing repetitive motions
- muscle spasms in your shoulder or arm
You may still be able to use your arm, because there are two tendons that attach the biceps to the shoulder.
Usually only the long biceps tendon tears. It is called the long head of the biceps muscle. The second, shorter tendon, called the short head of the biceps muscle, stays attached.
Possible causes of Popeye deformity include:
- overuse of your biceps muscle
- repetitive motion of your biceps
- sports injury
- injury from a fall
As you age, your biceps tendons may become worn and frayed from use. This is part of the natural aging process and may increase the chance of a tendon tear.
Other factors that may increase your risk of a Popeye deformity include:
- corticosteroid use
- anabolic steroid use
- rheumatoid arthritis
- fluoroquinoione antibiotics
- statin therapy
Before diagnosing Popeye deformity, your doctor will take a medical history, discuss your symptoms, and physically examine you.
The bulge in your arm will be visible if you have a complete tear in the biceps tendon. A partial tear might not create an obvious bulge but may still cause pain and other symptoms.
Your doctor will likely order imaging tests to determine the extent of the injury. An MRI can usually show the extent of soft tissue injuries.
If your doctor suspects that there may be other injuries to your shoulder or elbow, they may order X-rays.
Treatment for Popeye deformity is usually conservative since the tendon heals on its own over time. The bulge may get smaller in time.
Your doctor may recommend surgery if:
- you have other injuries to the shoulder, such as a rotator cuff injury
- you’re a young athlete
- your occupation requires full use of your arm for repetitive motion (carpentry, for example)
- you’re unhappy with the way a Popeye deformity looks
- conservative treatment doesn’t relieve your pain
Discuss your options with your doctor. There are new surgical procedures that require minimal incisions to repair the tendon.
You’ll have physical therapy after surgery to help restore your arm function.
Conservative treatment involves the following:
Initially you should apply ice for 20 minutes at a time, a few times per day. This will help minimize the swelling. Wrap the ice or ice pack in a towel rather than putting it directly on your skin.
Use over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, aspirin, or naproxen, to reduce pain and swelling.
Modify your activities to avoid strenuous activity with your arms, such as weightlifting or other overhead motions. Don’t lift more than 10 pounds with the affected arm.
Your doctor may recommend using a sling for a while.
Your doctor may recommend physical therapy or occupational therapy two to three times a week. A professional therapist can work with you on:
- strengthening and stretching exercises for your arm and shoulder
- range-of-motion and flexibility exercises for your arm and shoulder
- occupational therapy to help you with your daily work activities
The therapist will give you a home exercise routine.
The outlook for Popeye deformity is good. With conservative treatment, your pain should lessen. Over time, the bulge may also lessen. Recovery time is four to eight weeks.
Physical therapy can help you regain flexibility and strength in your arm. You may lose 20 percent of your lifting strength but not your grip or extension.
If you have surgery, the outlook is also good, but full recovery may take longer than recovery with conservative treatment. Total recovery from surgery may take a year.
Preventing Popeye deformity requires a commonsense approach in your activities. It may be useful to consult with a professional physical therapist or trainer to make sure you are using proper form in any exercise, sport, or repetitive activity.
Tips to prevent Popeye deformity
- Start any new fitness routine slowly, and don’t overdo it.
- Learn how to lift properly, bending at your knees instead of from your waist.
- If your work involves repetitive arm motions, take breaks.
- Get help if you have to lift something very heavy.
- Avoid overhead lifting and lifting with your arm fully extended.
- If you feel pain when exercising, stop. Use ice and NSAIDs to reduce inflammation and pain.
- Stop smoking and stop recreational steroid use. (Always check with a doctor before stopping prescribed medication.)
- See a doctor if your pain persists.