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Popeye Deformity

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The biceps muscle goes from the shoulder to the elbow. And when it ruptures at the shoulder area it is called a "popeye" muscle. The biceps muscle supinates the forearm and flexes the elbow (Figure 1).

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Rupture of the proximal biceps tendon is most often in association with a rotator cuff tear (Figure 2). The rupture usually involves the long head of the biceps.

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The diagnosis is often obvious for complete ruptures because of the deformity of the arm muscle. The tendon is injured; the muscle is shortened and goes towards the elbow area. The muscle becomes like a big ball (Popeye muscle) (Figure 3).

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There is a minimal loss of function with a long head rupture because the short head of the biceps remains attached to the coracoid process. Rupture of the biceps proximally (the popeye muscle) at the shoulder may not need surgery. The patient may complain of subjective cramps. Rupture of the biceps tendon at the elbow is different, it will need surgery to preserve the function of elbow flexion and forearm supination.