A CASE TO POINT: GROIN PULL

Acetylcholine (ACh) is an organic, polyatomic ion that acts as a neurotransmitter in both the
Peripheral Nervous System (PNS) and Central Nervous System (CNS) in many organisms including
humans. Acetylcholine is one of many neurotransmitters in the Autonomic Nervous System (ANS) and
the only neurotransmitter used in the motor division of the Somatic Nervous System (Sensory Neurons
use glutamate and various peptides at their synapses.

Acetylcholine has functions both in the PNS and in the CNS as a neuromodulator in the
peripheral nervous system, acetylcholine activates muscles and is a major neurotransmitter in the
autonomic nervous system. In the central nervous system, acetylcholine and its associated neurons form
the cholinergic system.

When acetylcholine reaches receptors on the membranes of muscle fibers, membrane channels
open and the process that contracts related muscle fibers begins. Open channels allow an influx of
sodium ions into the cytoplasm of muscle fiber.

The body needs a balance of acetylcholine and dopamine, another chemical messenger, to
control movement well.

Muscarinic Receptor Antagonist (MRAs) function by competitively blocking the cholinergic

response manifested by Acetylcholine (ACh) binding muscarinic receptors on exocrine glandular cells,
cardiac muscle cells, and smooth muscle cells. Therefore, MRAs are heavily involved with the
parasympathetic nervous system and act on different types of muscarinic receptors resulting in a wide
array of clinic indications.
 Muscarinic receptors are predominantly present on glandular cells, smooth muscle cells, and
cardiac muscle cells. The parasympathetic nervous system releases ACh, which binds to and activates
muscarinic receptors resulting in an anticholinergic response.

A Muscarinic Receptor Antagonist (MRA) is a type of anticholinergic agent that blocks the
activity of the muscarinic acetylcholine receptor. The muscarinic receptor is a protein involved in the
transmission of signals through certain parts of the nervous system, and muscarinic receptor antagonists
work to prevent this transmission from occurring. Notably, muscarinic antagonists reduce the activation
of the parasympathetic nervous system.

Groin Pull

Definition:

A groin strain is an injury or tear to any of the adductor muscles of the thigh. These are the
muscles on the inner side of the thigh. Sudden movements usually trigger an acute groin strain, such as
kicking, twisting to change direction while running, or jumping. Athletes are most at risk for this injury.
Groin strains aren’t usually serious, although a severe strain may take a long time to recover from.

Symptoms:

Symptoms of a groin strain can range from mild to severe, depending on the degree of the
injury. They can include:

 pain (usually felt in the inner thigh, but located anywhere from the hip to the knee)
 decreased strength in the upper leg
 swelling
 bruising
 difficulty walking or running without pain
 snapping sound at the moment of injury

Treatment:

Immediately after injury, the goal of treatment for a groin strain is to reduce pain and swelling. The
first few days of treatment follow the protocol for any muscle injury:

 rest
 ice
 compression
  elevation
 nonsteroidal anti-inflammatory drugs (for select individuals)

Depending on the severity of your strain, you may need additional treatments to speed healing.
These could include:

 physical therapy
 massage therapy
 heat and stretching
 electrotherapy
V. SYSTEM PATHOLOGY DUCHENNE MUSCULAR DYSTROPHY

CRITICAL THINKING AND CLINCAL APPLICATIONS

Duchenne Muscular Dystrophy (DMD) is a genetic disorder characterized by progressive muscle

degeneration and weakness due to the alterations of a protein called dystrophin that helps keep muscle
cells intact. DMD is one of four conditions known as dystrophinopathies.

CAUSES:

Certain genes are involved in making proteins that protect muscle fibers. Muscular dystrophy
occurs when one of these genes is defective.

Each form of muscular dystrophy is caused by a genetic mutation particular to that type of the
disease. Most of these mutations are inherited.

SYMPTOMS:

This is the most common form. Although girls can be carriers and mildly affected, it's much more
common in boys.

Signs and symptoms, which typically appear in early childhood, might include:

 Frequent falls
 Difficulty rising from a lying or sitting position
 Trouble running and jumping
  Waddling gait
 Walking on the toes
 Large calf muscles
 Muscle pain and stiffness
 Learning disabilities
 Delayed growth

COMPLICATIONS:

The complications of progressive muscle weakness include:

 Trouble walking. Some people with muscular dystrophy eventually need to use a wheelchair.
 Trouble using arms. Daily activities can become more difficult if the muscles of the arms and
shoulders are affected.
 Shortening of muscles or tendons around joints (contractures). Contractures can further limit
mobility.
 Breathing problems. Progressive weakness can affect the muscles associated with breathing.
People with muscular dystrophy might eventually need to use a breathing assistance device
(ventilator), initially at night but possibly also during the day.
 Curved spine (scoliosis). Weakened muscles might be unable to hold the spine straight.
 Heart problems. Muscular dystrophy can reduce the efficiency of the heart muscle.
 Swallowing problems. If the muscles involved with swallowing are affected, nutritional
problems and aspiration pneumonia can develop. Feeding tubes might be an option.

DIAGNOSIS

In diagnosing any form of muscular dystrophy, a doctor usually begins by taking a patient and
family history and performing a physical examination. Doctors may find pseudohypertrophy, lumbar
spine deviation, gait abnormalities, and several grades of diminished muscle reflexes.

Much can be learned from these observations, including the pattern of weakness. A patient’s
history and physical go a long way toward making a diagnosis, even before any complicated diagnostic
tests are done.