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Popeye Deformity—An Augenblick Diagnosis

Published:January 06, 2014DOI:https://doi.org/10.1016/j.amjmed.2013.11.025
      Some diagnoses, once seen, permit an immediate recognition, resulting in an “Augenblick” (blink of the eye) diagnosis.
      • Kitchens C.S.
      Thoughts on the diagnostic process.
      Examples are the shuffling gait and paucity of arm movement in Parkinsonism, the morphologic appearance of acromegaly or Marfan syndrome rapidly suggesting the condition, the unwavering hoarseness of recurrent laryngeal paralysis (perhaps better called “hörenkurz”—hearing momentarily) or the Popeye deformity of the ruptured long head of the biceps.
      A 57-year-old man, while running, fell onto his left side with an outstretched arm, with hyperextension at the shoulder. A few weeks later he reached up rapidly to catch a thrown object with a sudden, very severe, very short-lived shoulder pain, with the resulting deformity pictured (Figure; Video, available online). A magnetic resonance imaging study of the shoulder revealed a cleavage tear of the anterior aspect of the labrum and absence of the long head of the biceps, compatible with a tear of the proximal aspect of the tendon.
      Figure thumbnail gr1
      FigureThe unsecured proximal long head of the biceps (LHB) bunches into the Popeye deformity with biceps contraction.
      The most frequent sites of long head of the biceps rupture are at the origin and at the exit of the bicipital groove at the musculotendinous junction. The loss of the superior attachment of the biceps allows the biceps to bunch distally, resulting in the “Popeye deformity” (named for the cartoon character who gained a pointy big biceps from eating spinach). Long head of the biceps rupture accounts for 96% of all biceps brachii injuries, occurring most commonly in those over age 50 years.
      • Elser F.
      • Braun S.
      • Dewing C.B.
      • Giphart J.E.
      • Millett P.J.
      Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon.
      The rupture is usually transverse. The only long-term loss of function is slight weakness of supination (mean loss of 21%), and conservative treatment is usually indicated. John Elway went on to win 2 Super Bowls after this injury in his throwing arm. Surgical repair may be considered for younger patients, for cosmetic reasons, for occupations such as carpentry requiring full supination strength, or when surgery for the shoulder is otherwise required, such as for impingement syndrome and rotator cuff repair.
      • Azar F.M.
      Traumatic disorders.
      Our patient continued to swim long distances competitively without performance loss and with very little discomfort.

      Supplementary Data

      References

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        Anatomy, function, injuries, and treatment of the long head of the biceps brachii tendon.
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        Traumatic disorders.
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