UMEM Educational Pearls


81 year-old man was mowing the lawn and then felt a sudden pop, then pain in his left arm. What's the diagnosis and what's this sign called?


Biceps tendon rupture (BTR) aka Popeye's Sign

  • BTR can be related to degenerative issues in the elderly or acute injuries associated vigorous bicep use (e.g., weight lifting). Patients report a "popping" sound followed by sharp, sudden pain, ecchymosis and swelling.
  • Diagnosis is clinical; a palpable mass is seen between the shoulder and the elbow. The tendon typically ruptures on the proximal end, causing coiling of the muscle distally. ROM is maintained because only one bicep tendon ruptures, the remaining one functions normally.
  • Medical management is appropriate and emergency surgery is unnecessary (except for athletes or patient who rely on muscle strength for occupational purposes) Rupture of the distal bicep tendon ruptures requires surgical referral. 


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