Proximal Long Head Biceps Rupture: A Predictor of Rotator Cuff Pathology

Primary diagnosis of ruptured biceps tendon “Baker's‐type cyst” using fine needle aspiration biopsy: A case report

“…The clinical context in this case, including acute onset of the right arm mass with a characteristic “Popeye sign” and history of chronic right‐sided rotator cuff injury, together with the cytologic findings were consistent with a ruptured long head of the biceps tendon and so‐called “Baker's‐type cyst” of the arm . A retrospective review of 116 patients with an acute (<12 weeks) “Popeye” deformity of the biceps showed a significant proportion of patients also had associated rotator cuff tendon tears (supraspinatus or subcapsularis) on MRI (99/116, 85%, P < 0.001) . These patients were significantly older than those with an intact rotator cuff (mean age 63.3 ± 10.7 vs. 54.2 ± 9.2; P = 0.001).…”

“…4 A retrospective review of 116 patients with an acute (<12 weeks) "Popeye" deformity of the biceps showed a significant proportion of patients also had associated rotator cuff tendon tears (supraspinatus or subcapsularis) on MRI (99/116, 85%, P < 0.001). 1 These patients were significantly older than those with an Another potential risk factor for biceps tendon rupture is corticosteroid injection, although our patient did not provide this history. 7 In contrast to our patient's clinical presentation, ruptured biceps tendons are reported to occur more commonly in middle-aged men with acute or sub-acute rotator cuff injuries or in younger patients with heavy lifting.…”

“…Rupture of the biceps tendon is a well-described clinical entity with characteristic physical exam features that generally presents in middleaged to older individuals and is associated with rheumatoid arthritis and rotator cuff injuries. [1][2][3][4][5] The long head of the biceps tendon is involved in the majority of cases (up to 96% in some studies) 6 , and proximal rupture may be associated with a palpable mass overlying the biceps muscle due to synovial fluid tracking down from the shoulder. In such cases, flexion of the elbow produces a noticeable "Popeye" sign.…”

Elderly patient with mass on the right arm of sudden onset

“…In most cases, a biceps brachii rupture occurs at the proximal insertion, involving the long head of the muscle 1. It is more common in the elderly with a history of chronic shoulder pain, recurrent microtrauma or flexion against the forced extension 2.…”

Editorial Commentary: “Popeye” Deformity After Spontaneous Proximal Biceps Tendon Rupture: Image, Treat, or Ignore?

“…In addition, there have been numerous studies documenting the efficacy of surgical tenotomy and tenodesis to treat the pain associated with painful biceps pathology when the tendon does not rupture. 2,3 In their paper "Proximal Long Head Biceps Rupture: A Predictor of Rotator Cuff Pathology," 4 Kowalczuk, Kohut, Sabzevari, Naendrup, and Lin ask an important and previously neglected question: what is the incidence of rotator cuff pathology in patients with spontaneous ruptures of the proximal biceps tendon? Although the presence of biceps pathology in the presence of rotator cuff tears has been well documented in our literature, 3 Kowalczuk et al now take the opposite tack.…”