A Bad Day on the Slopes

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Comprehensive Assignment
MWF 12:55-1:50pm Heather Mischlich, Jessy Dawson, and Sean Finch

The First Run
1. Recall that Joanne's heart and respiratory rate were increased, and that her mouth was dry before she started her run. Explain what was happening to her autonomic nervous system (including which division is the most active) and trace the pathway of the ANS controls that were creating the symptoms noted. What changes do you think were occurring in her digestive and urinary systems at this time? (5 points) Her Autonomic Nervous system was showing signs of increased sympathetic activity (Martini, Nath 531). Sympathetic Activation: Suprarenal glands release adrenaline which binds to adrenergic receptors causing sympathetic domination in blood increasing blood glucose and fatty acids for energy needs Increased Heart Rate: Pre-ganglionic fibers adrenal medulla stimulation and release of norepinephrine into blood stream binds to adrenergic receptors increase heart rate During sympathetic activity Sympathetic trunk over powers Vagus nerve to prevent decreased heart rate. Increased Respiration Rate: The Cardiac and Pulmonary plexuses from the Sympathetic trunk send messages to the lungs to dilate bronchial pathways which increases respiration depth Dry Mouth: Results from the shutdown of parasympathetic watery secretions (Martini, Nath 534-536) Digestive system sphincters are contracted which means opened and motility is ceased Urinary system sphincters are contracted which means opened and bladder walls relax (Moore, Dalley 39-43) 2. Consider the action of skiing from the perspective of the hip and knee joints. Analyze those actions and create a table that shows what muscles, under control of what nerves, pull on what bones to cause each action. Be sure to include the isometric, isotonic concentric and isotonic eccentric actions as needed. The first column for your table must be the action. This column should describe what is occurring in both English and anatomical terminology (see chapter 9). But only include those actions needed for skiing and group the muscles together by action, with the prime mover listed first. Points will be deducted for unneeded actions. See example below*. (7 points) Action Sking straight and Fast Squatting in tucked position Muscle used are those used to Semimebranous Muscle Gluteus Maximus Origin Ilium, sacrum Insertion Femur Nerve Inferior gluteal nerve

Ischium

Tibia

Sciatic Nerve

Extending at hip (Eccentric) Extension at knee (Eccentric) Rectus Femoris Vastus (intermedius, lateralis, medialis)muscles Flexing at hip (Eccentric) Flexing at knee (Isometric) Biceps femoris Ischium and Femur Fibula and Tibula Rectus Femoris Femur Tibia Femoral Nerve Semitendinosus Ischium Ilium Tibia Tibia Sciatic Nerve

Ilium

Tibia

Femural Nerve

Sciatic Nerve

Gastrocnemius Stabilizing legs Keeping skies from crossing Hip Abduction Keeping skies from crossing Lateral hip rotation Keep from doing the splits Hip Adduction Adductor (longus, brevis, magnus) muscles Gluteus medius Satorius

Femur

Calcaneus

Tibial Nerve

ilium Iliac spine

Femur Tibia

Superior Gluteal nerve Femoral Nerve

Pubis

femur

Obturator nerve

Carving left and Right One leg squatting at hip and knee Hip and knee extension Muscles listed above for hip and knee extension, these muscles are elongating.

(eccentric isotonic)

Hip and knee flexion (concentric isotonic) Muscles listed above for hip and knee flexion, except now these muscles are actively flexing the skeletal structures of the knee and hip and are shortening.

One leg is straightening Hip and knee extension (concentric isotonic) Hip and knee flexion (eccentric isotonic)

Muscles listed above for hip and knee extension, these muscles are are now actively extending the skeletal structures of the knee and hip and are shortening

Muscles listed above for hip and knee flexion, these muscle are elongating

(Hamill, Knutzen 200-234), (Martini, Nath 316-318), (Martini, Nath 371-378) 3. Now, pick one of those muscles and trace its control from the appropriate brain structure all the way to the NMJ. Be sure to include all intermediate structures, synapses, plexuses and nerves. (5 points) Motor homunculus for anterior thigh of the motor cortex of the frontal lobe of the cerebrum cerebral peduncle in mesencephalon decussation of pyramids in medulla oblongata Corticospinal/pyramidal tract Synapses on lower motor neurons on the lateral anterior gray horns Lumbar nerves L2, L3, L4 Lumbar plexus femoral nerve Neuromuscular junction Upper deep portion of Rectus Femoris (Hamill, Knutzen 333-342) 4. Recall that during the first run, Joanne’s thigh muscles were burning. Explain the level of muscle activity involved, and note what metabolic process was providing most to the energy for Joanne’s muscles at that time. What energy molecule is she consuming at this time and what caused her muscles to feel like they were burning? What might Joanne have the night before to increase her endurance today? (5 points) Joanne’s muscles were in peak activity and were acquiring energy from anaerobic metabolism of glucose through glycolisis. The energy molecule that she is consuming during this activity is Glucose (Martini, Nath 319-320). Joanne’s muscles feel like they were burning due to a buildup of lactic acid. Joanne’s endurance could have been increased from a dinner with a sufficient amount of carbohydrates, proteins, and fats; and an adequate amount of sleep in loose fitting pj’s. (Martini, Nath 320).

The Second Run

5. After the first run, Joanne has decreased the demands her muscles are making. What metabolic process is now providing most of the energy for her muscles? What muscle protein has been storing Oxygen for this activity? Why are her heart and respiratory rates still high even though she is no longer working as hard? (4 points) Joanne’s muscles are in moderate activity acquiring energy from aerobic respiration. Myoglobin has been storing oxygen for this activity. Her heart and respiratory rates are still increased due to oxygen debt. Her body still requires more oxygen post activity to perform functions. Rates will stabilize after oxygen debt has been repaid (Martini, Nath 319-323). 6. Recall that Joanne could see the snow blowing machines below her on the second ride to the top. Trace the image of the blowing snow to perception. (Include all focusing, transduction, transmission and perception processes and structures) (5 points) Stimulus Conjunctiva Cornea Aqueous humorLens Vitreous body Retina (Transduction, Cones and Rods) Optic nerve (Transmission) Optic chiasm Visual tract Visual Cortex (Perception) (Martini, Nath 566-576) 7. Recall that during the “white out” Joanne lost her equilibrium. Trace the two equilibrium pathways (static and dynamic) from their receptors to their two points of perception. Then explain how the loss of visual cues disrupted this process. (5 points)

After the Fall
8. Recall that Joanne lost consciousness and awoke with a headache. Using those two symptoms, explain what CNS injury Joanne must have had. List at least one possible medical consequence of that injury. (That is, what might happen to make it worse?) (4 points) Joanne could have had a cerebral contusion caused by a sudden impact of a moving brain against the cranium. Since a contusion is a collection of blood, her elevated heart rate could have caused more bleeding. Any problem that increased blood flow to the head would make the micro hemmorage worse and increase intracranial pressure (Moore, Agur 507). 9. Trace the sensation of pain in Joanne’s left knee from the receptor to perception in the brain. Be sure to include the nerve and all intermediate structures involved in relaying this sensation. (5 points) Dendritic nerve endings (nociceptors) at knee to tibial nerve sciatic nerve in sacral plexus to rami of L4-S3 through Dorsal root ganglia crosses spinal cord ascends up lateral spinothalamic tract to Medulla to Thalamus to primary sensory cortex in post central gyrus of parietal lobe (Martini, Nath 507-525)

10. What is the most likely knee injury that Joanne has suffered and explain why you think that is the most likely. (More than one answer may be possible: pick one and explain it.) (4 pts)Torn Anterior Cruciate Ligament: In her situation it is most likely a torn Anterior Cruciate Ligament because it was to our belief that there was not enough weight on her left knee joint to cause a meniscus cartilage tear. After eliminating the possibility of the injury being a meniscus tear the fact that she twisted her knee laterally and heard a popping sound solidified our belief that it was indeed an Anterior Cruciate Ligament tear. 11. Describe two different possible injuries to Joanne’s shoulder that could account for the popping sound and the pain. For each of these injuries, include a description of the specific structure involved, the type of tissue injured and the immediate response of the body to that injury. Describe how each tissue type will affect the repair process. (note: the two injuries must damage different tissues). a. Possible injury 1: (4 pts) Broken Clavicle b. Possible injury 2: (4 pts) Acromioclavicular Joint Injury Broken Clavicle: Occurs from either

12. Create a table that shows the actions normally allowed around the shoulder and which muscles, under control of which nerves cause those actions. Use the same format at for #2. (7 pts) Action All concentric isotonic contractions Move arm backward and toward the body: Extension and Adduction at Shoulder Extension and Adduction at Shoulder Latissimus dorsi Vertebrae Humerus Thoracodorsal nerve (C6-C8) Teres major Scapula Humerus Lower subscapular nerve (C5-C6) Muscle Origin Insertion Nerve

Extension and Adduction at Shoulder Move arm toward the body and in front of the body toward the center: Adduction and Flexion at shoulder Adduction and Flexion at Shoulder Flexion at Shoulder Turning arm away and moving arm away from the body: (Rotator Cuff muscles and Deltoid) Medial Rotation at Shoulder Lateral Rotation at Shoulder Lateral Rotation at Shoulder Abduction at Shoulder Abduction at Shoulder Move arm forward and down with turning of shoulder blade:

Triceps brachii; long head Coracobrachialis

Scapula

Ulna

Radial nerve (C6-C8)

Scapula

Humerus

Musculocutaneous nerve (C5-C7)

Pectoralis major Biceps brachii Subscapularis

Ribs Scapula Scapula

Humerus Radius Humerus

Pectoral nerves (C5-T1) Musculocutaneous nerve (C5-C6) Subscapular nerves (C5-C6)

Infraspinatus Teres minor Supraspinatus Deltoid Subclavius

Scapula Scapula Scapula Clavicle & Scapula 1st Rib

Humerus Humerus Humerus Humerus Clavicle

Suprascapular nerve (C5-C6) Axillary nerve C5 Suprascapular nerve C5 Axillary nerve (C5-C6) Nerve to subclavius (C5C6)

Depression and Protraction at Shoulder Depression and Protraction at Shoulder; Rotation of Scapula Protraction at Shoulder; Rotation of Scapula Move arm inward and down with turning of shoulder blade: Adduction of Scapula and downward Rotation Raise shoulder blades upward: Elevation of Scapula Elevation of Scapula Trapezius Occipital bone Clavicle & Scapula Levator scapulae Vertebrae 1-4 Scapula Cervical nerves (C3-C4) and Dorsal scapular nerve C5 Accessory nerve (N-XI) and Cervical spinal nerves (C3-C4) Pectoralis minor Ribs 3-5 Scapula Medial pectoral nerve (C8,T1)

Serratus anterior

Ribs 1-8 or Scapula 1-9 Vertebrae Scapula

Long thoracic nerve (C5-C7) Dorsal scapular nerve C5

Rhomboid major & Rhomboid minor

13. Identify the components of the homeostatic control system that was trying to keep Joanne’s body warm and then explain specifically how that system works, including the messaging system involved. Be sure to classify this thermal injury and to explain how Joanne’s skin would change in response.(5 pts) 1.Normal set point for body temperature is disturbed. 2.Body temperature decreases. 3.Receptors in the skin and hypothalamus sense change. 4.Information is sent to thermoregulatory center of the hypothalamus. 5.The hypothalamus sends commands to effectors, blood vessels and skeletal muscles. 6.Actions done by effectors are vasoconstriction by the blood vessels in the limbs to retain core body temp and shivering of the skeletal muscle generates heat. 7.Body temperature is restored to set point.

The thermal injury involved is hypothermia, a condition in which the bodies core temperature drops below 95 degrees Fahrenheit disrupting the bodies metabolic functions. Joanne’s skin would be deprived of vital circulation due to extended periods of vasoconstriction causing her skin cells to die. (UMMC) 14. If you were on the ski patrol and found Joanne in this state, explain what treatments she would require, in what order of importance, and explain your reasoning for both the treatment and the order. (6 pts) (1)Possible head trauma – after asking her if she lost consciousness and her replying yes… I would make sure to secure the head and neck with a neck brace on a snow sled, while also isolating any movement of the spine. This is the most vital of all her treatments due to the possible risk of cranial and spinal injuries the severity of these injuries in long term recovery. (2)Preventing Hypothermia and shock The skier would then be wrapped in a wool or thermal blanket to keep her body temperature up, preventing shivering and vasoconstriction as well as preventing post injury shock. (3)Treating physical injuries- After she told me her knee and shoulder popped and are in pain… not to say these injuries are trivial, but they are the last to be treated because they are not going to get any worse without immediate treatment Shoulder – I would isolate the shoulder by wrapping the arm and securing it her body This should prevent any unnecessary pain from moving the injured joint. Knee – The knee would be splinted in a straight position if possible, otherwise it would be immobilized in whatever position that could be medically achieved. (Hudson)

Example Table for question 2 and 10 *The Table should be organized with the action listed first, then the muscles, then the origin and insertion and nerve for each needed muscle. Only list the muscles that are actually needed. DO NOT simply copy the information from the textbook, but THINK about what is needed for these movements and list them. See example below: To grasp a ski pole, you would: Action Curl your fingers: Muscle Flexor Digitorum Superficialis Origin Medial Condyle of Humerus and Anterior Radius and Ulna Insertion Middle Phalanges of digits 2-5 Nerve Median Nerve

Flex at the interphalangeal joints of digits 2-5 Flex at the interphalangeal joints of digits 2-5 Curl your Thumb Flexor Digitorum Profundus Flexor Pollicis longus

Medial and Posterior Ulna

Distal Phalanges of digits 2-5

Median and Ulnar Nerves

Anterior Radius

Distal Phalanx of digit 1 (thumb)

Median Nerve

Flex at the interphalangeal joints of thumb Pull thumb toward rest of hand Oppose your thumb (saddle joint)

Flexor Pollicis brevis Opponens Pollicis

Scaphoid and Trapezium Trapezium* * These bones form the saddle joint)

Proximal Phalanx of thumb First Metacarpal*

Median and Ulnar Nerves Median Nerve

Adduct your thumb

Adductor Pollicis

Carpals and metacarpals

Proximal phalanx of thumb

Ulnar Nerve

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