Muscular Case Study 4*

 

Patty Martin, a 36 year-old woman, was skiing fantastic powder snow in Utah. As the morning progressed, she noticed progressive fatigue in her quadriceps muscles with each run down the slopes. Because the powder was so deep and fresh, she decided not to eat lunch and kept skiing. At about 3:00 P.M. she was "flying" down the slope when she ran into some moguls hidden underneath the powder. She fell backwards with a slight twisting motion. While falling she felt a popping sensation inside her left knee, followed by intense pain. She tried to stand up, but then felt faint. A ski patrol came by and took her down the mountain in a toboggan.

 

During the physical examination the ski patroller noticed that Patty's knee was markedly swollen. There was no ligamentous laxity noted as her lower leg was moved side-to-side. However there was a positive drawer test when in the sitting position on the examination table and bending her knees to ninety degrees, the ski patroller was able to pull Patty's lower left leg forward.

 

 

QUESTIONS

 

1         What are the functions of ligaments, tendons and cartilage? Explain.

Describe motion at the five joints; give an example of each:
-Ball and Socket
-Hinge
-Pivot
-Gliding
-Fixed (immovable)

2. Describe structure of skeletal muscle at sarcomere level. Explain the Sliding-Filament Mechanism for muscle contraction.

3. How should the ski patroller treat the injury before Patty is driven down  the mountain?

4. What is the cause of the swelling in her knee?  What specific space is the fluid in? What is the function of the fluid?

5. What is the probable diagnosis? What evidence supports your diagnosis?  What further evidence would be needed to confirm the diagnosis?

6. Explain the surgical procedure that would be used to repair the damage on Patty’s knee.

7.
What are some problems that may occur if the damaged structure is not repaired?

 

*A&P Clinical Case Studies

—Prepared by Marc Walters, M.D., Portland Community College