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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 Muscle Origin Insertion Nerve

Sking straight and Fast Gluteus Maximus Ilium, Femur Inferior gluteal
sacrum nerve
Squatting in tucked
position
Muscle used are those Semimebranous Ischium
used to Tibia Sciatic Nerve
Extending at hip
Semitendinosus Ischium
(Eccentric) Tibia Sciatic Nerve

Extension at knee Ilium Tibia


Rectus Femoris
(Eccentric)

Vastus Femur Tibia Femoral Nerve


(intermedius,
lateralis,
medialis)muscles

Flexing at hip Rectus Femoris Ilium Tibia Femural Nerve


(Eccentric)

Flexing at knee Ischium and Fibula and


Biceps femoris Femur Tibula
(Isometric) Sciatic Nerve

Gastrocnemius Femur Calcaneus Tibial Nerve

Stabilizing legs
Keeping skies from
crossing
ilium Femur Superior
Gluteus medius
Hip Abduction Gluteal nerve

Keeping skies from Satorius Iliac spine Tibia Femoral Nerve


crossing
Lateral hip rotation

Keep from doing the Adductor (longus, Pubis femur Obturator nerve
splits brevis, magnus)
muscles
Hip Adduction

Carving left and Right


One leg squatting at Muscles listed above for hip and knee extension, these muscles
hip and knee are elongating.
Hip and knee extension
(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
Muscles listed above for hip and knee extension, these muscles are
Hip and knee extension are now actively extending the skeletal structures of the knee and hip
and are shortening
(concentric isotonic)

Hip and knee flexion


(eccentric isotonic) 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 build-
up 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 Muscle Origin Insertion Nerve

All concentric
isotonic contractions

Move arm backward Teres major Scapula Humerus Lower subscapular nerve
and toward the body: (C5-C6)

Extension and
Adduction at
Shoulder

Extension and Latissimus dorsi Vertebrae Humerus Thoracodorsal nerve


Adduction at (C6-C8)
Shoulder
Extension and Triceps brachii; Scapula Ulna Radial nerve (C6-C8)
Adduction at long head
Shoulder

Move arm toward Coracobrachialis Scapula Humerus Musculocutaneous nerve


the body and in front (C5-C7)
of the body toward
the center:

Adduction and
Flexion at shoulder

Adduction and Pectoralis major Ribs Humerus Pectoral nerves (C5-T1)


Flexion at Shoulder

Flexion at Shoulder Biceps brachii Scapula Radius Musculocutaneous nerve


(C5-C6)

Turning arm away Subscapularis Scapula Humerus Subscapular nerves


and moving arm (C5-C6)
away from the body:

(Rotator Cuff
muscles and Deltoid)

Medial Rotation at
Shoulder

Lateral Rotation at Infraspinatus Scapula Humerus Suprascapular nerve


Shoulder (C5-C6)

Lateral Rotation at Teres minor Scapula Humerus Axillary nerve C5


Shoulder

Abduction at Supraspinatus Scapula Humerus Suprascapular nerve C5


Shoulder

Abduction at Deltoid Clavicle & Humerus Axillary nerve (C5-C6)


Shoulder Scapula

Move arm forward Subclavius 1st Rib Clavicle Nerve to subclavius (C5-
and down with C6)
turning of shoulder
blade:
Depression and
Protraction at
Shoulder

Depression and Pectoralis minor Ribs 3-5 Scapula Medial pectoral nerve
Protraction at (C8,T1)
Shoulder; Rotation of
Scapula

Protraction at Serratus anterior Ribs 1-8 or Scapula Long thoracic nerve


Shoulder; Rotation of 1-9 (C5-C7)
Scapula

Move arm inward Rhomboid major & Vertebrae Scapula Dorsal scapular nerve
and down with Rhomboid minor C5
turning of shoulder
blade:

Adduction of Scapula
and downward
Rotation

Raise shoulder Levator scapulae Vertebrae Scapula Cervical nerves (C3-C4)


blades upward: 1-4 and Dorsal scapular
nerve C5
Elevation of Scapula

Elevation of Scapula Trapezius Occipital Clavicle & Accessory nerve (N-XI)


bone Scapula and Cervical spinal
nerves (C3-C4)

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 Muscle Origin Insertion Nerve

Curl your fingers: Flexor Medial Condyle of Middle Phalanges Median Nerve
Digitorum Humerus and of digits 2-5
Superficialis Anterior Radius and
Ulna
Flex at the inter-
phalangeal joints of
digits 2-5

Flex at the inter- Flexor Medial and Posterior Distal Phalanges of Median and
phalangeal joints of Digitorum Ulna digits 2-5 Ulnar
digits 2-5 Profundus
Nerves

Curl your Thumb Flexor Pollicis Anterior Radius Distal Phalanx of Median Nerve
longus digit 1 (thumb)

Flex at the inter-


phalangeal joints of Flexor Pollicis Proximal Phalanx
thumb brevis Scaphoid and of thumb Median and
Trapezium Ulnar Nerves

Pull thumb toward rest Opponens Trapezium* First Metacarpal* Median Nerve
of hand Pollicis
* These bones form
Oppose your thumb the saddle joint)
(saddle joint)

Adduct your thumb Adductor Carpals and Proximal phalanx Ulnar Nerve
Pollicis metacarpals of thumb

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