Intraoperative Estimation of the Popeye Sign by Electrical Stimulation of the Musculocutaneous Nerve Following Shoulder Biceps Tenotomy

Younger patients in particular may require biceps tenodesis following tenotomy to avoid the development of a biceps “Popeye deformity.” It is, however, difficult to predict whether a tenodesis is cosmetically necessary, since this deformity develops to a very variable degree, as the biceps muscle will retract in the postoperative course to an unknown amount with active contraction. Through the intraoperative electrical stimulation of the musculocutaneous nerve, the maximal contraction of the muscle can intraoperatively be provoked and thus the amount of Popeye deformity becomes apparent. We conclude that this method could be useful for intraoperative decision making if biceps tenodesis is needed and helps to avoid this surgical step and its associated risks, which otherwise often is performed unnecessarily, just in case.