{"id":20,"date":"2024-04-04T05:48:55","date_gmt":"2024-04-04T02:48:55","guid":{"rendered":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/115-isomeetrilised-testid-vastupanuga\/"},"modified":"2024-04-05T16:21:17","modified_gmt":"2024-04-05T13:21:17","slug":"115-isomeetrilised-testid-vastupanuga","status":"publish","type":"page","link":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/115-isomeetrilised-testid-vastupanuga\/","title":{"rendered":"11.5. Isomeetrilised testid vastupanuga"},"content":{"rendered":"

K\u00fc\u00fcnarliigest \u00fcmbritsevate lihaste j\u00f5u hindamiseks teostatakse isomeetrilised testid vastupanuga. K\u00fc\u00fcnarliigese painutajalihaste j\u00f5ud on suurim kui k\u00fc\u00fcnarliiges on painutatud 90-110\u00b0 ning k\u00fc\u00fcnarvars on supineeritud. Kui k\u00fc\u00fcnarliiges on painutatud 45\u00b0 kuni 135\u00b0 on v\u00f5imalik lihasj\u00f5udu rakendada vaid 75% maksimumist. On t\u00f5estatud, et meeste k\u00fc\u00fcnarliigest \u00fcmbritsevate lihaste j\u00f5ud on kaks korda tugevam kui naistel, k\u00fc\u00fcnarliigese sirutusj\u00f5ud on 60% painutusj\u00f5ust ning k\u00fc\u00fcnarvarre pronatsioonj\u00f5ud on 85% supinatsioonj\u00f5ust. Kui teatud liigutus v\u00f5i liigutused p\u00f5hjustavad testi ajal ebamugavust v\u00f5i valu, v\u00f5imaldab tabel 1 selgitada valu p\u00f5hjuse. Vastupanuga teostatud isomeetrilised testid peab sooritama ka randmeliigese sirutuse ja painutuse suunal, sest mitmed k\u00fc\u00fcnarliigese funktsioonidega seotud lihased \u00fcletavad ka randmeliigese.\u00a0 <\/span><\/p>\n

TABEL 1. K\u00dc\u00dcNAR- JA RANDMELIIGEST \u00dcMBRITSEVATE LIHASTE FUNKTSIOON, N\u00c4RV JA N\u00c4RVIJUURE INNERVATSIOON.<\/h5>\n\n\n\n\n\n\n\n\n\n
\n

Funktsioon<\/span><\/span><\/span><\/strong><\/p>\n<\/td>\n

\n

Lihas<\/span><\/span><\/span><\/strong><\/p>\n<\/td>\n

\n

N\u00e4rv<\/span><\/span><\/span><\/strong><\/p>\n<\/td>\n

\n

N\u00e4rvijuur<\/span><\/span><\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

K\u00fc\u00fcnarliigese fleksioon<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m brachialis<\/span><\/span><\/span><\/p>\n

m biceps brachii<\/span><\/span><\/span><\/p>\n

m brachioradialis<\/span><\/span><\/span><\/p>\n

m pronator teres<\/span><\/span><\/span><\/p>\n

m flexor carpi ulnaris<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

musculocutaneous<\/span><\/span><\/span><\/p>\n

musculocutaneous<\/span><\/span><\/span><\/p>\n

radial<\/span><\/span><\/span><\/p>\n

median<\/span><\/span><\/span><\/p>\n

ulnar<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

C5-C6 (C7)<\/span><\/span><\/span><\/p>\n

C5-C6<\/span><\/span><\/span><\/p>\n

C5-C6 (C7)<\/span><\/span><\/span><\/p>\n

C6-C7<\/span><\/span><\/span><\/p>\n

C7-C8<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

K\u00fc\u00fcnarliigese ekstensioon<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m triceps brachii<\/span><\/span><\/span><\/p>\n

m anconeus<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

radial<\/span><\/span><\/span><\/p>\n

radial<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

C6-C8<\/span><\/span><\/span><\/p>\n

C7-C8 (T1)<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

K\u00fc\u00fcnarvarre supinatsioon<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m supinator<\/span><\/span><\/span><\/p>\n

m biceps brachii<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

posterior interosseous (radial)<\/span><\/span><\/span><\/p>\n

musculocutaneous<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

C5-C6<\/span><\/span><\/span><\/p>\n

C5-C6<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

K\u00fc\u00fcnarvarre pronatsioon<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m pronator quadratus<\/span><\/span><\/span><\/p>\n

m pronator teres<\/span><\/span><\/span><\/p>\n

m flexor carpi radialis<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

anterior interosseous (median)<\/span><\/span><\/span><\/p>\n

median<\/span><\/span><\/span><\/p>\n

median<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

C8-T1<\/span><\/span><\/span><\/p>\n

C6-C7<\/span><\/span><\/span><\/p>\n

C6-C7<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Randmeliigese fleksioon<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m flexor carpi radialis<\/span><\/span><\/span><\/p>\n

m flexor carpi ulnaris<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

median<\/span><\/span><\/span><\/p>\n

ulnar<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

C6-C7<\/span><\/span><\/span><\/p>\n

C7-C8<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Randmeliigese ekstensioon<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m extensor carpi radialis longus<\/span><\/span><\/span><\/p>\n

m extensor carpi radialis brevis<\/span><\/span><\/span><\/p>\n

m extensor carpi ulnaris<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

radial<\/span><\/span><\/span><\/p>\n

posterior interosseous (radial)<\/span><\/span><\/span><\/p>\n

posterior interosseous (radial)<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

C6-C7<\/span><\/span><\/span><\/p>\n

C7-C8<\/span><\/span><\/span><\/p>\n

C7-C8<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

K\u00fc\u00fcnarliigest \u00fcmbritsevate lihaste isomeetriline j\u00f5ud hinnatakse vastupanuga k\u00fc\u00fcnarliigese fleksiooni ja ekstensiooni, k\u00fc\u00fcnarvarre supinatsiooni ja pronatsiooni ning randmeliigese fleksiooni ja ekstensiooni suundadel.<\/h6>\n

K\u00fc\u00fcnarliigest \u00fcmbritsevate lihaste vastupanuga teostatud isomeetriliste testide ajal patsient istub, \u00f5lavars on kehat\u00fcve k\u00f5rval ning k\u00fc\u00fcnarliiges on painutatud 90\u00ba. M\u00e4rguande peale \u201e\u00e4ra lase end liigutada\u201c, teostatakse isomeetrilised testid vastupanuga j\u00e4rgmistel funktsioonidel: k\u00fc\u00fcnarliigese <\/span>ekstensioon (joonis 8A), k\u00fc\u00fcnarliigese fleksioon (joonis 8B), k\u00fc\u00fcnarvarre supinatsioon (joonis 8C), k\u00fc\u00fcnarvarre pronatsioon (joonis 8D), randmeliigese fleksioon (joonis 8E), randmeliigese ekstensioon (joonis 8F).<\/span><\/p>\n

\"11-8\"<\/p>\n

Joonis 8. K\u00fc\u00fcnarliigest \u00fcmbritsevate lihaste isomeetrilised testid vastupanuga. A \u2013 k\u00fc\u00fcnarliigese ekstensioon; B \u2013 k\u00fc\u00fcnarliigese fleksioon; C \u2013 k\u00fc\u00fcnarvarre supinatsioon; D \u2013 k\u00fc\u00fcnarvarre pronatsioon; E \u2013 randmeliigese fleksioon; F \u2013 randmeliigese ekstensioon.<\/h5>\n

Kui patsient kurdab valu v\u00f5i ebamugavustunnet koormusega seotud kombineeritud liigutustel, korduvatel liigutustel v\u00f5i staatilistes asendites, v\u00f5ib p\u00e4rast isomeetrilisi vastupanuga teostatud p\u00f5hiteste hinnata ettevaatlikult, samuti isomeetriliselt, patsiendi poolt kirjeldatud liigutusi v\u00f5i asendeid. On teada, et \u00f5lavarre kakspealihas on tugev k\u00fc\u00fcnarliigese painutajalihas ning k\u00fc\u00fcnarvarre supinatsiooni teostav lihas, kuid vastava j\u00f5u genereerimise v\u00f5ime s\u00f5ltub k\u00fc\u00fcnarliigese asendist. \u00d5lavarre kakspealihase j\u00f5ud on suurem kui k\u00fc\u00fcnarvars on supineeritud, v\u00e4iksem kui k\u00fc\u00fcnarvars on proneeritud. <\/span><\/p>\n

Kui isomeetriliste testide ajal on lihaskontraktsioon n\u00f5rk, kuid valuvaba, v\u00f5ib kahtlustada kontraktiilsete v\u00f5i neuroloogiliste kudede t\u00f5sist vigastust. K\u00fc\u00fcnarliigese painutus- ja supinatsioonij\u00f5u n\u00f5rkus ilmneb \u00f5lavarre kakspealihase distaalse k\u00f5\u00f5luse rebendi korral siis, kui leid j\u00e4rgneb \u00e4kilisele, teravale valule k\u00fc\u00fcnarliigese eesmises \u00f5\u00f5nsuses, spetsiifiliselt ajal, mil k\u00fc\u00fcnarliigest painutades avaldub sirutuse suunaline j\u00f5ud. Trauma v\u00f5i vigastuse puudumisel v\u00f5ib lihasj\u00f5u n\u00f5rkus olla seotud kas n\u00e4rvijuure v\u00f5i perifeerse n\u00e4rvi kahjustusega. Valikuliste lihastestide, aga ka sensoorse tundlikkuse hindamisega on v\u00f5imalik tuvastada\u00a0 n\u00e4rvi vigastus (tabel 2).\u00a0\u00a0 <\/span><\/p>\n

Tabel 2. K\u00fc\u00fcnarliigese funktsioonidega seotud n\u00e4rvivigastus.<\/h5>\n\n\n\n\n\n\n\n\n
\n

N\u00e4rv<\/span><\/span><\/strong><\/p>\n<\/td>\n

\n

Motoorne defitsiit<\/span><\/span><\/strong><\/p>\n<\/td>\n

\n

Tundlikkuse h\u00e4ire<\/span><\/span><\/strong><\/p>\n<\/td>\n

\n

Funktsioonih\u00e4ire<\/span><\/span><\/strong><\/p>\n<\/td>\n<\/tr>\n

\n

Mediaann\u00e4rv (C6-C8, T1)<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m pronator teres<\/span><\/span><\/span><\/p>\n

m flexor carpi radialis<\/span><\/span><\/span><\/p>\n

m palmaris longus<\/span><\/span><\/span><\/p>\n

m flexor digitorum superficialis<\/span><\/span><\/span><\/p>\n

m flexor pollicis longus<\/span><\/span><\/span><\/p>\n

m flexor digitorum profundus lateraalne osa<\/span><\/span><\/span><\/p>\n

m pornator quadratus<\/span><\/span><\/span><\/p>\n

kaks lateraalset lumbrikaallihast<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

Palmaarselt- p\u00f6ial, nimetiss\u00f5rm, keskmine s\u00f5rm ja s\u00f5rmuse s\u00f5rme lateraalne osa.<\/span><\/span><\/span><\/p>\n

Dorsaalselt- distaalselt kolmandik nimetiss\u00f5rmest, keskmine s\u00f5rm, s\u00f5rmuse s\u00f5rme lateraalne osa<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

Pronatsioon n\u00f5rk v\u00f5i puudub.<\/span><\/span><\/span><\/p>\n

N\u00f5rk randmeliigese fleksioon ja ulnaardeviatsioon.<\/span><\/span><\/span><\/p>\n

Puudulik radiaaldeviatsioon.<\/span><\/span><\/span><\/p>\n

V\u00f5imetus l\u00e4hendada v\u00f5i painutada p\u00f6ialt.<\/span><\/span><\/span><\/p>\n

N\u00f5rk p\u00f6idla eemaldus.<\/span><\/span><\/span><\/p>\n

N\u00f5rk pigistusj\u00f5ud ja n\u00e4pistamine.<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Eesmine interosseous n\u00e4rv (mediaann\u00e4rviharu)<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m flexor pollicis longus<\/span><\/span><\/span><\/p>\n

m flexor digitorum profundus lateraalne osa<\/span><\/span><\/span><\/p>\n

m pornator quadratus<\/span><\/span><\/span><\/p>\n

kaks lateraalset lumbrikaallihast<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

Puudub<\/span><\/span><\/span><\/p>\n

\u00a0<\/span><\/p>\n<\/td>\n

\n

N\u00f5rk k\u00fc\u00fcnarvarre pronatsioon, eriti 90\u00b0 k\u00fc\u00fcnarliigese fleksiooni korral.<\/span><\/span><\/span><\/p>\n

N\u00f5rk p\u00f6idla l\u00e4hendamine ja fleksioon.<\/span><\/span><\/span><\/p>\n

N\u00f5rk s\u00f5rmede painutus.<\/span><\/span><\/span><\/p>\n

N\u00f5rk n\u00e4pistamine.<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Ulnaarn\u00e4rv<\/span><\/span><\/span><\/p>\n

(C7-C8, T1)<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m flexor carpi ulnaris<\/span><\/span><\/span><\/p>\n

m flexor digitorum profundus mediaalne osa<\/span><\/span><\/span><\/p>\n

m palmaris brevis<\/span><\/span><\/span><\/p>\n

m adductor pollicis<\/span><\/span><\/span><\/p>\n

kaks mediaalset lumbrikaallihast<\/span><\/span><\/span><\/p>\n

k\u00f5ik luudevahelihased<\/span><\/span><\/span><\/p>\n

\u00a0<\/span><\/p>\n<\/td>\n

\n

Dorsaalne ja palmaarne osa v\u00e4ikesest ja mediaalne osa s\u00f5rmuse s\u00f5rmest<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

N\u00f5rk randmeliigese fleksioon.<\/span><\/span><\/span><\/p>\n

Puudulik ulnaardeviatsioon.<\/span><\/span><\/span><\/p>\n

Puudulik v\u00e4ikese s\u00f5rme distaalne fleksioon.<\/span><\/span><\/span><\/p>\n

Puudulik s\u00f5rmede eemaldamine ja l\u00e4hendamine<\/span><\/span><\/span><\/p>\n

V\u00f5imetus sirutada teist ja kolmandat s\u00f5rmeliigest v\u00e4ikeses ja s\u00f5rmuse s\u00f5rmes.<\/span><\/span><\/span><\/p>\n

Puudulik p\u00f6idla l\u00e4hendamine.<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Radiaaln\u00e4rv<\/span><\/span><\/span><\/p>\n

(C5-8, T1)<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m anconeus<\/span><\/span><\/span><\/p>\n

m brachioradialis<\/span><\/span><\/span><\/p>\n

m extensor radialis longus, brevis<\/span><\/span><\/span><\/p>\n

m extensor digitorum<\/span><\/span><\/span><\/p>\n

m extensor pollicis longus et brevis<\/span><\/span><\/span><\/p>\n

m abductor pollicis longus<\/span><\/span><\/span><\/p>\n

m extensor carpi ulnaris<\/span><\/span><\/span><\/p>\n

m extensor indicies<\/span><\/span><\/span><\/p>\n

m extensor digiti minimi<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

Dorsaalselt labak\u00e4si (kaks kolmandikku lateraalselt)<\/span><\/span><\/span><\/p>\n

Dorsaalselt ja lateraalselt p\u00f6ial<\/span><\/span><\/span><\/p>\n

Dorsaalselt kaks kolmandikku nimetiss\u00f5rm, keskmine s\u00f5rm ja pool s\u00f5rmuse s\u00f5rm<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

Puudulik k\u00fc\u00fcnaravarre supinatsioon. Puudulik randmeliigese sirutus.<\/span><\/span><\/span><\/p>\n

V\u00f5imetus haarata.<\/span><\/span><\/span><\/p>\n

V\u00f5imetus stabiliseerida rannet.<\/span><\/span><\/span><\/p>\n

Puudulik s\u00f5rmede sirutus.<\/span><\/span><\/span><\/p>\n

V\u00f5imetus eemaldada p\u00f6ialt.<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n

\n

Tagumine interosseous n\u00e4rv<\/span><\/span><\/span><\/p>\n

(radiaaln\u00e4rvi<\/span><\/span><\/span>haru)<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

m extensor carpi radialis brevis<\/span><\/span><\/span><\/p>\n

m extensor digitorum<\/span><\/span><\/span><\/p>\n

m extensor pollicis longus et brevis<\/span><\/span><\/span><\/p>\n

m abductor pollicis longus<\/span><\/span><\/span><\/p>\n

m extensor carpi ulnaris<\/span><\/span><\/span><\/p>\n

m extensor indices<\/span><\/span><\/span><\/p>\n

m extensor digiti minimi<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

Puudub<\/span><\/span><\/span><\/p>\n<\/td>\n

\n

N\u00f5rk randme sirutus.<\/span><\/span><\/span><\/p>\n

N\u00f5rk s\u00f5rmede sirutus.<\/span><\/span><\/span><\/p>\n

Raskused randme stabiliseerimisel.<\/span><\/span><\/span><\/p>\n

Raskused haaramisel.<\/span><\/span><\/span><\/p>\n

V\u00f5imetus eemaldada p\u00f6ialt.<\/span><\/span><\/span><\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n","protected":false},"excerpt":{"rendered":"

K\u00fc\u00fcnarliigest \u00fcmbritsevate lihaste j\u00f5u hindamiseks teostatakse isomeetrilised testid vastupanuga. K\u00fc\u00fcnarliigese painutajalihaste j\u00f5ud on suurim kui k\u00fc\u00fcnarliiges on painutatud 90-110\u00b0 ning k\u00fc\u00fcnarvars on supineeritud. Kui k\u00fc\u00fcnarliiges on painutatud 45\u00b0 kuni 135\u00b0 on v\u00f5imalik lihasj\u00f5udu rakendada vaid 75% maksimumist. On t\u00f5estatud, et …<\/p>\n","protected":false},"author":9,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-20","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages\/20","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/users\/9"}],"replies":[{"embeddable":true,"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/comments?post=20"}],"version-history":[{"count":2,"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages\/20\/revisions"}],"predecessor-version":[{"id":679,"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages\/20\/revisions\/679"}],"wp:attachment":[{"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/media?parent=20"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}