A ‘Popeye muscle’ describes the bulge that appears in the upper arm after a biceps tendon rupture, resembling the cartoon character Popeye’s exaggerated biceps. This bulge forms because the muscle retracts and bunches up. Understanding repair options and available treatments is important for those affected.
Understanding the “Popeye Muscle” Injury
The “Popeye muscle” is a common visual sign of a biceps tendon rupture, where the biceps muscle detaches from its anchor point. The biceps muscle, located on the front of the upper arm, connects to bones at the shoulder and elbow via tendons. It has two heads at the shoulder and a single tendon at the elbow. Most ruptures occur in the long head of the biceps tendon at the shoulder, but can also happen at the elbow (distal biceps tendon rupture).
This injury often results from sudden, forceful events like lifting heavy objects or falling onto an outstretched arm. Chronic overuse and age-related wear can also fray the tendon, making it prone to tearing. When a tendon tears, a person may hear or feel a “pop” or “snap,” followed by sudden, sharp pain in the upper arm or elbow. Other signs include bruising, swelling, and weakness in bending the elbow or rotating the forearm. The characteristic bulge forms because the torn tendon can no longer hold the muscle, causing it to retract.
Treatment Approaches for Biceps Tendon Rupture
Addressing a biceps tendon rupture involves considering both non-surgical and surgical approaches, with the choice depending on factors such as the individual’s activity level, age, and the tear’s location and severity. Non-surgical management is often suitable for less active individuals, older patients, or those with partial tears, especially for proximal biceps tendon ruptures at the shoulder. This approach focuses on pain relief, reducing swelling, and maintaining arm function through rest, ice, nonsteroidal anti-inflammatory drugs, and physical therapy. While it can alleviate symptoms, non-surgical treatment may result in persistent weakness, particularly in forearm rotation, and the visible “Popeye” deformity will remain.
Surgical repair is recommended for active individuals, athletes, or those requiring full restoration of strength and function, especially for distal biceps tendon ruptures at the elbow. Unlike proximal tears, a distal rupture often leads to significant loss of forearm supination (twisting the forearm palm up) and flexion strength if not surgically repaired. Surgery aims to reattach the torn tendon to its bone, maximizing strength recovery. Delaying repair beyond a few weeks can make the procedure more challenging due to scarring and muscle retraction.
Surgical Repair: Procedure and Recovery
Surgical repair of a biceps tendon rupture involves reattaching the torn tendon to its bone. For a distal rupture at the elbow, a surgeon makes a small incision over the forearm to locate the detached tendon. The torn end is cleaned, and the bone (radius) is prepared to secure the tendon using sutures, anchors, or screws. This procedure is performed as an outpatient operation. For proximal ruptures at the shoulder, a procedure called biceps tenodesis may be performed, where the torn tendon is detached from its original shoulder attachment and reattached to the upper arm bone (humerus).
Following surgery, the arm is immobilized in a sling or brace for several weeks to protect the repair and allow initial healing. Pain management and swelling reduction are priorities during this immediate post-operative phase. Physical therapy begins with passive range of motion exercises, where the arm is moved gently by another person, within the first two weeks. This progresses to active range of motion exercises around four weeks post-surgery, allowing the patient to move the arm independently. Strengthening exercises are gradually introduced, starting with light resistance around six to eight weeks, with a full return to strenuous activities taking four to six months or longer.
Life After Repair: What to Expect Long-Term
The long-term outcomes following a biceps tendon rupture depend on the chosen treatment path. For those who undergo surgical repair, especially for distal tears, the prognosis for regaining strength and function is favorable, with many patients achieving near-normal strength in elbow flexion and forearm supination. While good recovery is common, some individuals may experience minor residual weakness, stiffness, or occasional discomfort. Re-injury of the repaired tendon is uncommon.
In cases managed non-surgically, particularly for proximal biceps ruptures, individuals can perform most daily activities. However, they may experience a permanent cosmetic deformity (the ‘Popeye’ bulge) and some persistent weakness, especially with forceful forearm rotation. Studies suggest non-operative management can result in approximately 50% loss of supination strength and around 30% loss of flexion strength compared to the uninjured arm. Regardless of treatment, maintaining physical activity and adhering to a structured exercise program can help optimize long-term arm health and function.