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Muscle mass, body mass index, and surgical treatment of LHBT pathology as well as patient perceptions can all influence the prevalence and functional effect of the Popeye sign. This article reviews the historical origin of the eponym and its clinical relevance. Furthermore, we propose a novel, standardized diagnostic grading system to quantify the Popeye sign, facilitating more consistent reporting in future clinical research.<\/jats:p>","DOI":"10.5397\/cise.2026.00038","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:55:22Z","timestamp":1778720122000},"page":"284-290","update-policy":"https:\/\/doi.org\/10.5397\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Popeye sign: beyond the bulge\u2014a proposal for a standardized definition and classification"],"prefix":"10.5397","volume":"29","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-3192-887X","authenticated-orcid":true,"given":"Igor J","family":"Shirinskiy","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lotte","family":"Fokker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5146-6148","authenticated-orcid":true,"given":"Michel PJ","family":"van den Bekerom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5134-7384","authenticated-orcid":true,"given":"Bart","family":"Muller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6948-183X","authenticated-orcid":true,"given":"Derek FP","family":"van Deurzen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"3351","reference":[{"key":"ref1","volume-title":"","author":"Segar","year":"1929"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1056\/nejmicm1704705"},{"key":"ref3","volume-title":"Biceps tendon rupture [Internet]","author":"Hsu","year":"2023"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2008.06.021"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1186\/s13018-019-1429-x"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2020.10.040"},{"key":"ref7","volume-title":"","author":"Grandinetti","year":"1994"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1215\/03616878-30-5-803"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1080\/1081602x.2022.2034658"},{"key":"ref10","volume-title":"","author":"Trinklein","year":"2020"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1177\/03635465000280011701"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.1002\/ca.23610"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1053\/j.otsm.2006.12.004"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1186\/s12891-023-06346-5"},{"key":"ref15","first-page":"22","volume-title":"Long head of biceps-a vestigial structure","author":"Garcia Jr","year":"2017"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-061954"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620x.89b8.19278"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1016\/j.csm.2015.08.010"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.180.3.1800633"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2017.10.050"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/j.jisako.2024.07.001"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2021.05.003"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1302\/0301-620x.94b11.29499"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.otsr.2017.09.016"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2015.11.036"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jseint.2024.10.015"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1016\/j.arthro.2024.11.069"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.asmr.2021.02.010"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1016\/j.jse.2018.01.006"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.3810\/psm.2010.06.1790"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2013.11.025"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1136\/bcr-2021-242908"},{"key":"ref33","first-page":"134","volume-title":"When is a conservative approach best for proximal biceps tendon rupture?","author":"Pugach","year":"2013"},{"key":"ref34","first-page":"233","volume-title":"Rupture of the tendon of the long head of the biceps brachii. 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