Popeye sign: causes, symptoms and treatments

The biceps is one of the largest muscles in the arm, so any of its components are prone to injury. Clear evidence of a muscle injury is the Popeye sign that appears after the rupture of any of the tendons of the muscle in question.

The name of this sign is due to a character from a 1930 cartoon, whose biceps had an exaggerated circular shape. This health problem can appear in individuals of any age. However, it is more common in men in their 50s.

It is important to remember that the biceps has two parts, a long head and a short head, each with its respective tendon. Studies show that tendon ruptures of the long head of the muscle are the most frequent, while the injury to the distal tendon is only seen in 3% to 10% of cases.

What are the symptoms?

The Popeye sign shows the presence of a tear in one of the biceps tendons.

First of all, it must be taken into account that the Popeye sign is a medical finding in itself, so the symptoms that will be referred to are those of the tendon rupture itself. The first symptom to present will be a sudden onset pain and a painful circular lump in the middle of the muscle.

On the other hand, people who present the sign in question may also report any of the following symptoms:

  • Clicking at the time of tendon rupture.
  • Bruising and tenderness in the upper arm.
  • Weakness in the shoulder and elbow.
  • Difficulty bending and turning the arm.
  • Muscle spasms in the affected area.

There are cases in which the mobility of the limb is not compromised, so the patient can execute certain movements with total normality. This is largely due to the anatomical composition of the muscle, which makes it possible for healthy fibers to carry out the movement of those that are injured.

Also read: What foods strengthen tendons and muscles?

Causes of the Popeye sign

In general terms, the Popeye sign only appears when there is a rupture of one of the biceps tendons, be it the long head, the short head or the distal tendon. These tendons can rupture from a host of different causes., wear being one of the most common.

The wear of the fibers can occur physiologically with age or pathologically when performing repetitive movements. Therefore, this type of injury is very common both in people over 50 as in professional athletes.

Direct causes that can cause a tendon to rupture include the following:

  • Overuse of muscle.
  • Direct trauma to the area.
  • Lifting an exaggerated weight.
  • Falls

Risk factor's

There are multiple conditions that can lead to wear of the biceps tendon, which in turn would facilitate its rupture. Fortunately, some of these factors are associated with lifestyle, so a simple modification could make them disappear.

The risk factors most associated with tendon wear are the following:

  • Smoke.
  • Excessive consumption of corticosteroids.
  • Use of anabolic steroids.
  • Tendinitis
  • Rheumatoid arthritis.


Diagnosing a tendon rupture is very simple in most cases, especially when there are obvious tests such as the Popeye sign. The sign in question is patonogmonic evidence of the lesion; that is unequivocally demonstrates the presence of it.

However, the specialist will be obliged to carry out the correct anamnesis to focus on the circumstance of the appearance of the symptoms. In addition, you should also perform the physical examination in order to assess the presence of pain and determine if there is compromise of mobility of the affected limb.

The doctor may also use imaging tests to assess the severity of the rupture. In this case, the test used is an ultrasound, which is very fast and inexpensive. It provides the specialist with a clear image of the injury, helping you choose the best therapy to follow.

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Available treatments

Treatment of the injury will be determined by its severity.

Fortunately, there are multiple techniques that the specialist can apply to treat a ruptured biceps tendon. The therapy to be followed will depend on the severity of the injuryConservative treatment will be more than sufficient in partial ruptures, while complete ruptures require surgery in most cases.

Surgical treatment

The most commonly used surgeries to treat pathologies that affect the long head of the biceps are tenotomy and tenodesis. Different investigations indicate that there is not a great difference between the effectiveness of both procedures and patients regain full functionality in most cases.

Tenotomy is a surgical technique in which the surgeon cuts a tendon in order to increase its length and thus correct an existing imbalance. For its part, tenodesis is the adherence of a tendon to a bone structure to allow muscle mobility.

Nevertheless, the patient must meet certain conditions to be a candidate for surgery, among which the following stand out:

  • Young athlete.
  • Having other shoulder injuries, such as a rotator cuff tear.
  • The occupation requires repetitive arm movement.
  • Conservative treatment does not relieve pain.

Non-surgical treatment

Tendons have the ability to regenerate themselves over time, so many times conservative treatment can alleviate the symptoms presented. In this sense, it is important to go to the doctor before starting any treatment, since this will be the only one capable of indicating an appropriate therapy.

Among the techniques that can be performed to improve the Popeye sign without any surgical intervention, the following stand out:

  • Ice application for 20 minutes a day.
  • Consumption of non-steroidal anti-inflammatory drugs (NSAIDs), such as paracetamol or naproxen.
  • Keep resting and do not lift more than 5 kilos with the affected arm.
  • Perform physical therapy 2 or 3 times a week.

Popeye sign prevention

The rupture of the biceps tendons is an injury that can be prevented, it will only be necessary be aware of the signals emitted by the body. In addition, special care must be taken when performing physical exercises, especially the person who is starting in the world of sports or if he or she performs a new training method.

It is important to avoid overuse of muscle, as constant movement can inflame tendons and weaken them if not treated properly. In this sense, it is important not to over-exercise the muscles and request help to lift some weight if necessary.

Lastly, it is important stop all types of physical activity if pain occurs during the activity. It should be taken into account that pain is a clear signal that something is not working properly in the body.

An uncomfortable pathology with effective treatment

The Popeye sign is a clear sign of a ruptured biceps tendon, although it may not be as obvious in all cases. People with this injury report muscle pain, whose intensity may vary depending on the severity of the situation.

This is one very common injury in high-performance athletes and in people over 50 years of age; it can affect the mobility of the arm in the long term. Fortunately, there are multiple techniques that can solve the situation in a timely manner and that have a fairly high success rate.