Did “Popeye” need an orthopedic doctor?

The 1960's cartoon sailor was famous for "popping" his biceps up after consuming a can of spinach. To an orthopedic doctor, however, he looked like the next patient about to walk in the door. Anyone whose biceps tendon has just torn, or popped and curled up is probably in a lot of pain. That damsel in distress will have to wait...sorry, Olive Oil!

The biceps are the strong upper arm muscles on the inside of the arm. Men over age 30 have the highest risk of rupturing the biceps tendon at the elbow. The muscles can tear or detach at the elbow or shoulder after a trauma such as falling on an outstretched arm, throwing something with great force, or lifting something too heavy. Overuse can also cause a tear or rupture of the biceps, especially if the patient uses the arm and shoulder for a lot of overhead motions. This means that the older a person is, the higher the risk for this type of injury.

The symptoms of a biceps tear or rupture are usually obvious to a good orthopedic doctor:

  • severe pain at the time of injury
  • a "pop" sound at the time of injury
  • loss of strength in the biceps
  • pain/difficulty turning the palm up and down
  • a lump where the detached biceps curled away from the elbow or shoulder
  • pain, bruising, and swelling after
  • cramping of the biceps when strained

Treatment depends on a patient's lifestyle needs:


Patients who are older or sedentary, in consultation with their orthopedic doctor, may elect not to have surgery. Patients whose health cannot endure having a small-to-medium surgery may also need to forego it. The arm can still function without the biceps attached. Turning the palm from down to up with any kind of force won't be possible, and the arm will lose a third or more of its strength. The arm can heal without surgery, but the biceps tendon will not restore itself. It will stay rolled up near the shoulder, shorten, and become less visible. By not having surgery, the patient needs to understand that the damage and reduced strength to the arm is permanent.


This is not recommended. The biceps tendon shortens and scars within 2-3 weeks after the injury. Surgical outcomes after this point are not as good and surgeries have more complications.


Active patients will likely want the biceps repaired. An orthopedic doctor specializing in the elbow and arm (upper extremity) is the best choice for a surgeon. He or she will likely be the most experienced with biceps tendon ruptures, since it's not a common injury. The surgeon will reattach the biceps tendon using metal hardware or stitches threaded through drilled holes in the forearm bone. Rehabilitation after surgery is gradual. The patient is often in a sling or cast at first, but moving the arm begins soon after surgery. Physical therapy is usually necessary. Healing from the surgery takes about 90 days, and it can be six months or more before the biceps tendon regains full strength.