I was in a shop the other day looking at tinned spinach! I must admit to not being a great fan of
the tinned version. Give me fresh spinach anytime! The cartoon character ‘Popeye’ used to get
his great muscular strength from spinach, apparently. The tinned variety! It was reputed to have
high iron content.
Great article in the BMJ the other day (1) about a ‘mass’ in the upper arm. This was due to a
ruptured distal biceps tendon, allowing the biceps to contract ‘up’ the arm, creating a bulge in
the upper arm, known as a ‘reverse Popeye’ sign. The much more common ‘Popeye’ sign
occurs when one of the two upper biceps tendons ruptures, allowing part of the biceps contract
’down’ the upper arm towards the elbow, creating a bulge that looks like Popeye’s bulging
muscles (2). We see this in practice more often, as it is much more common for one of these
two tendons to either rupture completely, or to partially tear (2), in particular the long head of the
biceps (3).
What causes these problems? One of the more common causes of upper biceps tendon rupture
is problems with the rotator cuff muscles of the shoulder (3). A common cause of rupture of the
distal biceps tendon is forced extension of the elbow at 90 deg, commonly done in weight
training, doing deadlifts, or arm wrestling (4). Beware!
With the upper tendons, often a non-surgical treatment is taken (5), but for rupture of the lower
tendon, surgery is generally required (6).
What can we take away from this?
● If you get pain when you elevate your arm above your head, you might have a problem
with the rotator cuff of your shoulder. This increases your chances of rupturing a biceps
tendon. Get it checked out
● Be careful with heavy lifting, especially if weight training
By the way, the iron content of spinach has been shown to be no greater than that of most green
vegetables. Apparently the original researchers got their decimal point in the wrong place! (7)
References:

1. Lui TH, Slocum AMY, Li CCH, Leung YT. Soft tissue mass of the anterior upper arm. BMJ.
   2025 Jan 9;e082173.
2. Thomas JR, Lawton JN. Biceps and Triceps Ruptures in Athletes. Hand Clin. 2017
   Feb;33(1):35–46.
3. Vestermark GL, Van Doren BA, Connor PM, Fleischli JE, Piasecki DP, Hamid N. The
   prevalence of rotator cuff pathology in the setting of acute proximal biceps tendon rupture. J
   Shoulder Elbow Surg. 2018 Jul;27(7):1258–62.
4. Tjoumakaris FP, Bradley JP. Distal Biceps Injuries. Clin Sports Med. 2020 Jul;39(3):661–72.
5. Hsu D, Anand P, Mabrouk A, Chang KV. Biceps Tendon Rupture. In: StatPearls [Internet].

Treasure Island (FL): StatPearls Publishing; 2025 [cited 2025 Jan 15]. Available from:
http://www.ncbi.nlm.nih.gov/books/NBK513235/

6. Bain GI, Prem H, Heptinstall RJ, Verhellen R, Paix D. Repair of distal biceps tendon rupture:
   A new technique using the endobutton. J Shoulder Elbow Surg. 2000 Mar;9(2):120–6.
7. Hamblin TJ. Fake. BMJ. 1981 Dec 19;283(6307):1671–4.