Popeye Sign Research Articles

Arthroscopic Release of the Long Head of the Biceps Tendon

Background Treatment of chronic, refractory biceps tendinitis remains controversial. The authors sought to evaluate clinical and functional outcomes of arthroscopic release of the long head of the biceps tendon. Hypothesis In specific cases of refractory biceps tendinitis, site-specific release of the long head of the biceps tendon may yield relief of pain and symptoms. Study Design Case series; Level of evidence, 4. Methods Fifty-four patients diagnosed with biceps tendinitis underwent arthroscopic release of the long head of the biceps tendon as an isolated procedure or as part of a concomitant shoulder procedure over a 2-year period. Patients were not excluded for concomitant shoulder abnormality, including degenerative joint disease, rotator cuff tears, Bankart lesions, or instability. Nine of 40 patients had an isolated arthroscopic release of the biceps tendon. At a minimum of 2 years, the American Shoulder and Elbow Surgeons; the University of California, Los Angeles; and the L'Insalata shoulder questionnaires as well as ipsilateral and contralateral metrics were used for evaluation. Results The L'Insalata; University of California, Los Angeles; and American Shoulder and Elbow Surgeons scores were 77.6, 27.6, and 75.6, respectively. Seventy percent had a Popeye sign at rest or during active elbow flexion; 82.7% of men and 36.5% of women had a positive Popeye sign (P <. 05); 68% were rated as good, very good, or excellent. No patient reported arm pain at rest distally or proximally; 38% of patients complained of fatigue discomfort (soreness) isolated to the biceps muscle after resisted elbow flexion. Conclusion Arthroscopic release of the long head of the biceps tendon is an appropriate and reliable intervention for patients with chronic, refractory biceps tendinitis. Cosmetic deformity presenting as a positive Popeye sign and fatigue discomfort were the primary complaints. Clinical Relevance Although tenotomy is not the ideal intervention for patients of all ages with various shoulder abnormalities, data suggest that it may be an acceptable surgical intervention for a specifically selected cohort of individuals.

Paper #107 Arthroscopic release of the long head of the biceps tendon: functional outcome and clinical results

The treatment of chronic, refractory biceps tendinitis remains controversial. The etiology of biceps tendinitis may involve pathology within the tendon, specifically along its course in the bicipital groove or at its insertion on the labrum. In specific cases where all other pathologies have been ruled out, site specific release of the long head of the biceps (LHBT) may yield relief of pain and symptoms. We sought to evaluate clinical and functional outcome in a cohort of patients who underwent arthroscopic release of the LHBT. 54 patients diagnosed with biceps tendinitis or biceps tendon instability underwent an arthroscopic release of the LHBT as either as isolated procedure or as part of another shoulder procedure over a 2yr period. 36pts were available for follow-up at a minimum of 18 months. Patients were not excluded for concomitant shoulder pathology that included DJD, rotator cuff tears (RCT), Bankart lesions, or instability. 11/36 had isolated arthroscopic release of the biceps tendon. Patients underwent a complete shoulder exam by one surgeon who was different than the surgeon performing the surgery at our institution and were scored based on ASES, UCLA, and L”Insalata functional shoulder questionnaires. In addition, ipsilateral and contralateral metrics were evaluated. Results of 36pts(10F, 26M: 49yrs) were evaluated at 2.3 yrs post-op (range 18-42 mos). L’Insalata, UCLA, and ASES scores were 70.1, 25.8, and 75.4 respectively. 26% had no Popeye sign (PS) at rest or during active elbow flexion. 17% had a +PS during rest and elbow flexion. 57% had no PS at rest, but a +PS during active elbow flexion. Side to side strength difference was 2.5 reps (10 lbs weight). 57% were rated as good, very good, or excellent. 43% of pts were graded as fair (N = 4) or poor (N = 6).Of 6 pts with a poor result, 2 had DJD, 2 had RCT, 2 had an acromioplasty. None of the patients reported arm pain at rest or proximally. 36% of pts complained of fatigue discomfort (soreness) isolated to the biceps muscle following resisted elbow flexion. 96% had mild to no biceps tenderness upon palpation of the becipital groove.