In cartoons a bulge in the bicep is the symbol of muscularity - and that someone has been eating their spinach. In real life though, such a bulge signals something very different - and it isn't caused by muscles at all. "It's the biceps tendon," said Peter Chalmers, MD, an orthopedic surgeon with University of Utah Health. "When it tears that causes the muscle to slump leading to what's known as the 'Popeye sign.'"
While a ruptured biceps tendon looks horrible it actually isn't that serious of an injury. The patient doesn't lose use of their arm, the pain is minimal, and the tendon often scars lower down on the arm functionally creating a repair. The muscle may end up in a slightly different position, but mostly things return to normal. The real concern with an injury like this is what else it signals. "The biceps tendon is kind of the canary of the shoulder," said Chalmers. "When it tears that's often a sign that there is another problem."
Arthritis could be the cause of the tendon rupture. Another culprit could be a problem with the rotator cuff. It could be inflamed or partially torn. "When a patient comes in with a biceps tendon rupture the first thing I do is check the rotator cuff," said Chalmers. "I will usually find that is where the problem originated and that the biceps tendon was secondarily affected."
Rotator cuff injuries are common in people employed in jobs with lots of arm motions like construction or house painting. Athletes like tennis players, basketball players, and baseball players also are at risk. These types of injuries are also more common as we age. "Repetitive arm motions and heavy lifting put strain on the rotator cuff," said Chalmers. "With age, that wear and tear can cause damage."
Recovering from a rotator cuff injury is possible and usually does not require surgery. "We always start with physical therapy and cortisone injections," said Chalmers. "Only if that doesn't work do we consider surgery."