BAB I

INTRODUCTION

1.1. Background

Human Body System Block is the fourth block in semester 1 of

Curriculum-Based Competence of Doctor Education Faculty of Medicine,
Muhammadiyah University of Palembang. In this block is taught about the
tools and systems that exist in the human body. In addition, as we know that
the learning program in this UMP FK uses KBK learning system, so it is
expected that doctor graduates from FK UMP become doctors who are able to
understand the existing systems in the human body.

On this occasion a case study of scenario A that presented the case Santo,
An 11 yeard old, brought by his mother to the puskesmas because of his
lower limbs suddenly cramps and pain after practicing breaststroke
swimming. He also self stiffness on upper arms. After being asked, he didn’t
warming up before swimming. Doctors exxplain about occurrence of cramps,
pain, and stiffness and also what muscle are involved in it.

1.2. Significance of the repost

The purpose and purpose of this Tutorial meteri, namely:
1. As a report task group tutorial that is part of KBK learning system at the
Faculty of Medicine, Muhammadiyah University of Palembang.
2. Can solve cases given in scenarios with analytical methods and group
discussions.
3. Achieving the objectives of the Tutorial learning method.

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 BAB 1I

DISCUSSION

2.1. Data

Tutor : dr.Dimyati Burhanuddin S.Ked. M.Sc

Master of ceremony : Puspa Nadiya

Secretary 1 : Arviani

Secretary 2 : Dinanti Bunga Fajar

Execution Time : Tuesday, 02 Januari 2018

Regulations :

1. Swith the phone off or in silence

2. Hold hands when asking questions and arguments
3. Ask for permission in advance when going out of the room
4. Each tutor member is expected to wear an id

2.2. Scenario B

“Oh My Lowers Limbs”

Santo, An 11 yeard old, brought by his mother to the puskesmas because of his
lower limbs suddenly cramps and pain after practicing breaststroke swimming. He
also self stiffness on upper arms. After being asked, he didn’t warming up before
swimming. Doctors exxplain about occurrence of cramps, pain, and stiffness and
also what muscle are involved in it.

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2.3. Seven Jump

2.3.1 Clarification of the promblem

Paint Feeling of disconfort or pain coused by

certain nerve endings
Cramps Spasmodic muscular contractions are
painful
Stiffness Rigid or feeling sore
Breastroke Swimming breastroke
Lower Limbs The limbs of the gluteus region of the
foot, serves to withstand body weight
and motion
Muscle Organs that produce motion in animal
organisms through contraction
Warming up A little practice before doing sport
Occurrence Events a day

2.3.2 Identification of problem

1. Santo, An 11 yeard old, brought by his mother to the puskesmas because

of his lower limbs suddenly cramps and pain after practicing breaststroke
swimming.

2. He also self stiffness on upper arms.

3. After being asked, he didn’t warming up before swimming. Doctors

explain about occurrence of cramps, pain, and stiffness and also what
muscle are involved in it

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2.3.3 Analyze of problem

1. Santo, An 11 yeard old, brought by his mother to the puskesmas because of his
lower limbs suddenly cramps and pain after practicing breaststroke swimming.

a. What does the meaninng of santo experiencing cramps and pain in the lower
limb after exerctise?

Jawab :

A condition in which the muscle. Suddenly contract out of the will, causing
pain, tightness and no relax

b. What anatomy structure lower limbs? (muscle, bone, joint, nerve, and
vascularition)

jawab :

Anatomy on the thigh

a) Muscle
1. M. Tensor fasciae latae
2. M. Sartosius
3. M. Pectineus
4. M. Adductor longus
5. M. Quadriceps femoris
 M. Vastus lateralis
 M. Rectus femoris
 M. Vastus medialis
 M. Vastus intermedius
6. M. Gracilis
7. M. Biceps femoris
8. M. Semitendinosus
9. M. Semimembranosus
10. M. Adductor brevis

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 11. M. Adductor magnus
b) Bone
1. Os femur
c) Vaskularisasi
1. A. femoralis
2. A. circumflexa femoris medialis
3. A. circumflexa femoris lateralis
4. A. profunda femoris
5. A. descendens genus
6. V. Femoralis
7. V. Cicumflexa femoris medialis
8. V. Circumflexa femoris lateralis
9. V. Profunda femoris
10. V. Saphena magna
d) Nerve
1. N. cutaneus surae lateralis
2. N. cutaneus dorsalis intermedius
3. N. fibularis superficialis
4. N. fibularis profundus
5. N. Cutaeus dorsalis medialis
6. N. fibularis profundus.
e) Joints
1. Articulatio coxae
2. Articulatio genus

(F.Paulsen & J.Waschake,2010)

c. What parts are used on the chest pool? (Neck, truncus, superior ekstremity :
explain muscle, bone, joint, nerve and vascularition)

Jawab :

 Extremitas superior

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a) Muscle
1. M. Biceps brachii
2. M. Brachialis
3. M. Triceps brachii
4. M. Brachioradialis
5. M. Extensor carpi radialis brevis
6. M. Anconeus
b) Bone
1. Os humerus
c) Vaskularisasi
1. A. Axillaris
2. A. brachialis
3. A. circumflexa humeri anterior
4. A. circumflexa humeri posterior
5. A. profunda brachii
6. A. collateralis ulnaris superior
7. A. collateralis media
8. A. collateralis radialis
9. A. collateralis ulnaris inferior
d) Inervasi
1. N. Radialis
2. N. Cutaneus brachii posterior
3. N. Cutaneus antebrachii posterior
4. N. ulnaris
5. N. cutaneus brachii lateralis inferior
6. N. cutaneus brachii lateralis superior
7. N. cutaneus brachii medialis
8. N. medianus
9. N. musculocutaneus
e) Joints
1. Articulatio humerii

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 2. Articulatio cubiti
 Neck
a) Muscle
1.m.trapezius
2.m.obliquus superior capitis
3.m.rectus posterior minor posterior
4.m.rectus capitis posterior major
5.m.obliquus capitis inferior
6.m.sternocleidomastoideus
7.m.spleinius capitis
8.m.spleineus cervicis
9.m.longissimus capitis
10. m. semispenalis capitis
b) Bone
1. Vertebrae cervicalis (I-VII)
c) Vascularization
1. A. Carotis interna
2. A. Carotis externa
3. A. Carotis communis
4. V. Internal Jugularis
5. V. External Jugularis
6. V. Anterior jugularis

(F.Paulsen & J.Waschake,2012)

d. What are the joint movent that accure when breastroke swimming? (
abduction of the shoolder joint)

Jawab :

Neck : Articulatio acromio-clavicularis, articulatio sterno clavicularis

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 Extremity of superior : Articulatio humeri, articulatio cubiti, articulatio
radio carpalis, articulatio radio ulnaris, articulatio
metacarpo phalangeal, articulatio interphalangeal.

Extremity of inferior : Amphiartrosis sacroiliaca, symphysis ossium pubis,

articulatio sacrococcygea, articulatio coxae,
articulatio metatarsophalangeal, articulatio
interphalangeal, articulatio tarsotranversa chopart,
articulatio tarsometatarsea lisfranc, articulatio
talotarsalis, articulatio tibiofibularis, syndesmosis
tibiofibularis, articulatio meniscofemoralis
medialis, articulatio meniscofemoralis lateralis,
articulatio meniscotibialis medialis, articulatio
meniscotibialislateralis,articulatio
femoropatellaris.

(F.Paulsen & J.Waschake,2012)

e. what is the mechanism of cramps?

Jawab :

Lack of blood flow to the muscles caused by the accumulation of lactic acid
in the bloodstream due to less than perfect metabolism. Lactic acid is
formed because in the muscle burning glycogen is broken into a chemical in
the form of pyruvate. If enough oxygen is present, the pyruvate will be
converted to the end result of carbon dioxide and water, which is released
through the lungs. But if there is insufficient oxygen in the muscle, pyruvate
is converted to lactic acid deposited in the muscle and then into the
bloodstream. Lactic acid interferes with muscle contractions increasingly
difficult. So the result appears tired. High levels of lactic acid will
eventually stop muscle contraction altogether. And there was a strong,
unwanted muscle contraction that ached.

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 (Guyton, Arthur C & John E. Hall. 2007)

f. What is the mechanism of pain? ( sensory path ways : receptor, central-

sensor)

Jawab :

1. The existence of disturbing stimuli that generate electrical activity

2. Then the stimulus is received by the primary afferent nerve, namely the
nociceptor
3. Nociceptors continue stimulation to the spinal cord that secretes the
substance P that activates the pain lines of assendens to different parts of
the brain:
 Reticular formation: increases the degree of alertness associated
with disturbing stimuli
 Thalamus: pain perception
 Somatosensory cortex: determining the location of the pain
(localization of pain

4. Then the interconnection of the thalamus and reticular formation to the

hypothalamus and limbic system triggers the behavioral and emotional
response that accompanies the painful experience).

(Price and Wilson, 2005 )

2. He also self stiffness on upper arms.

a. What is the anatomy structure of up arams? ( explain : muscle, bone, joint,

nerve, and vascularition)

jawab :

 truncus
1. Muscle and Nerve

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Otot
MusculusLatissimusDorsi
MusculusSerratus Posterior Superior
MusculusSerratus Posterior Inferior
MusculusObliquusInternus
MusculusObliquusEksternus
Musculus Erector Spinae
Persarafan
NervusThoracodorsalis (Plexus
Brachialis)
Cabang-cabang ventral dari C6-C8,
cabang-cabangsarafintercostalis 1 dan
2
Cabang-cabangsarafintercostalis XI
dan XII ; cabang-cabang ventral L1
dan L2
NervusIlioinguinalis,
Iliohypogastricus, Intercostalis
NervusIlioinguinalis,
Iliohypogastricus, Intercostalis
Nn.Cervicalis,
ThorachalesdanLumbales

 Extremitas Superior
1. Muscle
-M.deltodeus
-m.teres major
-m.teres minor
-m.bricepbrachii caput logum et lareve
-m.brachialis
-m.triceps brachii caput logum, laterale et mediale
-m.pronator teres caput humeral et ulnaris
-m.flexor carpi radialis
-m.palmaris longus
-m.flexor carpi ulnaris caput humerale et ulnaris
-m.brachioradialis
-m.palmaris brevis

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 -m.lumbricalis
-m.extensor carpi radialis brevis
-m.extensor digitorum
-m.extensor digiti minimi
-m.extensor carpi ulnaris
-m.acroneus
-m.supinator
-m.abductor pollicis longus
-m.extensor poillicis brevis
-m.extensor pollicis longus
-m.extensor indicis
2. Joint
-Joint clavicula medial (Articulatio sternoclavicularis)
-Joint clavicula lateral (Articulatio acromioclavicularis)
-Joint shoulder ( Articulatio humeri)
-Joint elbow (Articulatio cubiti)
-Joint wrist (Articulatio radiocarpae / carpi)
3. Bone
-Os scapula
-Os humerus
-Os radius
-Os ulna
-Os carpalis
-Os metacarpal
-Os phalanges
4. Vascularication
-Arteri axillaris
-Arteri brachialis
-Arteri radialis
-Vena chepalica
-Vena axillaris

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 -Vena brachialis
-Vena radialis
-Vena profunda beachii
5. Nerve

-N intercistabrachialis

-N cutaneus brachii medialis

-N cutaneus antebrachii lateralis

-N supraclaviculares laterales

(F.Paulsen & J.Waschake,2012)

b. What is the mechanism of stiffness?

Jawab :

Muscle stiffness is a visible symptom when the muscles can not move
quickly without pain and / or seizures. Patients should move slowly. They
quickly learn that after the muscles have not been used for some time, for
example when they wake up from sleep, or since sitting in one position for
some time their first movements must be very slow, gentle and tentative.
Moving too fast brings acute pain and may seizure. Seizures can occur when
the muscles are used excessively and tired, especially if overwhelmed or if it
has been held in the same position for long periods of time. As a result,
muscle cells run out of energy and fluids and become hyperexcitable and
then develop strong contractions. This seizure may involve part of the
muscle, the entire muscle, or even the adjacent muscles.
Excessive as a cause of skeletal muscle spasms is often seen in athletes who
perform heavy exercise in hot environments. It is also a matter of work with
construction workers. Usually, there will be a seizure in the large muscles
that are being asked to do the job. It is usually thought that dehydration and
electrolyte depletion will cause muscle spasms and cramps. Muscle cells
require adequate water, glucose, sodium, potassium, calcium, and

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 magnesium to allow proteins in themselves to interact and develop
organized contractions. The normal supply of these elements can cause the
muscles to become irritable and become seizures.

(Smeltzer & Bare).

3. After being asked, he didn’t warming up before swimming. Doctors explain

about occurrence of cramps, pain, and stiffness and also what muscle are
involved in it.

a. what is the benefit warming up before swimming?

Jawab :

1. Increase body temperature

2. Increase the body's metabolism so that the heart, the lungs are ready to
face the need for high metabolism while exercising
3. Reduce muscle tone
4. 4. Increase blood circulation throughout the body

b. what are muscle in vorved in this care?

Jawab :

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4. What is islamic view in this care?

Jawab :

“you have control over your body, Allah SWT does not advocate to work
excessively, you just need to balance between the world and your afterlife. “
( HR Tarmizi )
“O my people, work according to your circumstances, I will work, and you
shall know.” (Az-Zumar, 39:39).

2.3.4 conclusion

Santo, 11 years old suffers cramps and pain on lower limbs and also
stiffness on upper arms due to excessive muscle contraction

2.3.5 Conceptual Framework

Santo, 11yeard old No worming up

Excessive muscle contraction

Cram, pain (lower limbs) stiffness (upper arms)

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 REFERENCES

Paulsen, F dan Waschke, J. 2012. Sobotta Atlas Anatomi Manusia, Ed. 23.
Jilid 1.Jakarta: EGC.

Guyton, Arthur C & John E. Hall. 2007. Buku Ajar Fisiologi Kedokteran.
Jakarta: EGC

Snell, Richard S.2006. Anatomi Klinik Untuk Mahasiswa Kedokteran, Ed.

6. Jakarta : EGC.
Price, Sylvia A dan Wilson, Lorraine M. 2005. Patofisiologi. Ed. 6.
Jakarta : EGC
Moore, L. Keith and Dalley F. Arthur., 2013.Anatomi Berorientasi Klinis:
Ekstremitas Bawah, Ekstremitas atas Edisi ke-5. Jakarta : Erlangga

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