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The first 25 slides, exactly as they appear. The full deck has 79 content slides.
Orthopaedics
Skeletal Muscle
Built from Pillemer — Physical Signs in Orthopaedics and Neurology
What’s inside
8 sections · 79 slides
Overview
- What this topic teaches you
- How we will build the picture
Muscle: The Basics
What muscle is made of, and how skeletal muscle differs from the rest
- There are three kinds of muscle in the body
- The three muscle types side by side
- How a skeletal muscle is packaged
- The layered structure of skeletal muscle
How Muscles Contract
Shortening, lengthening, or holding still - all under tension
- A muscle can contract in three different ways
- Concentric, eccentric and isometric contraction
- The three contractions in a nutshell
- Why eccentric contraction matters more than it seems
Testing Motor Power
How weakness is graded for reports - and where the scale goes wrong
- Where the grading scale comes from
- The AMA grades of motor deficit
- The two easy anchors: Grade 5 and Grade 0
- The lower grades - and the problem with them
- The higher grades - closer to real function
- Why the scale gives such generous scores
- A worked example: the repaired radial nerve
- A more useful way to assess motor deficit
- A more useful way to assess the deficit
Pectoralis Major
The big chest muscle with two heads - and how to test one head alone
- Pectoralis major on the chest wall
- The muscle and its two heads
- The segments of pectoralis major
- Where it inserts - and a clever twist
- Its nerve supply comes from two cords
- The medial and lateral pectoral nerves
- What pectoralis major does
- Both heads standing out on resisted adduction
- Testing the clavicular head in isolation
- The clavicular head contracting on its own
- The sternocostal head staying flaccid
Tenodesis and the Tenodesis Effect
One idea linking tendon surgery to a clever paralysed-hand grip
- What tenodesis means
- Biceps tenodesis
- A rotator cuff repair is a tenodesis too
- Knotless rotator cuff repair
- Tenodesis in hand surgery
- The flexor pulley system of the finger
- The Zancolli lasso procedure
- Three variants of the Zancolli lasso procedure
- Now the tenodesis EFFECT - a normal reflex of the hand
- The tenodesis effect at the wrist
- The tenodesis effect after spinal cord injury
- A passive whole-hand grasp from the tenodesis effect
- Passive lateral grip from a tight FPL
- Using the tenodesis effect for diagnosis
- A divided flexor tendon revealed by wrist extension
- The Bunnell test for intrinsic tightness
- The Bunnell test for intrinsic tightness
Latissimus Dorsi and Teres Major
Two muscles, one shared action you can reason out
- Two muscles that share a job
- Latissimus dorsi
- Latissimus dorsi: origin, insertion, nerve
- The insertion of latissimus dorsi on the humerus
- Teres major: origin, insertion, nerve
- The origin of teres major on the scapula
- The insertion of teres major on the humerus
- A trick to recall their action: hand on your sacrum
- Reasoning out the action: hand to the sacrum, step 1
- Reasoning out the action: hand to the sacrum, step 2
Triceps Brachii
The one muscle at the back of the arm - and where we really use it
- The three-headed muscle at the back of the arm
- The three heads of triceps brachii
- Where the three heads arise
- The origin of the long head of triceps
- The origin of the medial head of triceps
- Humeral origins of the medial and lateral heads
- Insertion, nerve, and action
- The course of the radial nerve
- When do we actually use triceps?
- When we do NOT use triceps - and the golden rule
- Key takeaways
- Why does the AMA scale record only a 76-99% deficit for a Grade 1 muscle that has no useful function at all?
- References
- Physical Signs in Orthopedic and Neurologic Disorders: A Practical Guide