{"id":65,"date":"2024-04-04T05:49:00","date_gmt":"2024-04-04T02:49:00","guid":{"rendered":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/56-muotoomid\/"},"modified":"2024-04-04T05:52:27","modified_gmt":"2024-04-04T02:52:27","slug":"56-muotoomid","status":"publish","type":"page","link":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/56-muotoomid\/","title":{"rendered":"5.6. M\u00fcotoomid"},"content":{"rendered":"

\n\tPerifeersete liigeste hindamise j\u00e4rgselt hindab terapeut patsiendi lihasj\u00f5udu v\u00f5imaliku neuroloogilise n\u00f5rkuse tuvastamiseks (tabel 5). Iga m\u00fcotoomi eraldi hinnates asetatakse liiges kas neutraal- v\u00f5i puhkeasendisse, misj\u00e4rel avaldab terapeut vastavale liigutusele isomeetrilist vastupanu (tabel 6). V\u00f5imaliku lihasn\u00f5rkuse tuvastamiseks peab lihaskontraktsiooni s\u00e4ilitama v\u00e4hemalt 5 sekundit. Et v\u00f5rrelda samaaegselt m\u00f5lema alaj\u00e4seme lihaste j\u00f5udu, sooritatakse m\u00fcotoomitestid h\u00fcppeliigese plantaar- ja dorsaalfleksioonil ning inversiooni ja eversioonil, aga ka varvaste sirutamisel bilateraalselt. Samaaegne bilateraalne hindamine ei ole v\u00f5imalik puusa- ja p\u00f5lveliigeste testide korral, sest alaj\u00e4semete raskus ning liigne surve alaseljale takistavad testi \u00f5nnestumist. Terapeut peab avaldama liigutuslikku vastupanu hinnatavast liigesest distaalselt luu peal, mitte liigese peal, sest see v\u00f5ib takistada s\u00fcmptomite ilmnemist. N\u00e4iteks patsiendi seliliasendis, puusaliigese painutust teostavate lihaste hindamiseks asetab terapeut oma k\u00e4e patsiendi reieluule distaalselt. H\u00fcppeliigese liigutusi soovitatakse hinnata p\u00f5lveliiges ligikaudu 30\u00b0 painutatud asendis spetsiifiliselt siis, kui patsient kurdab ishiasvalu, sest t\u00e4ielik h\u00fcppeliigese dorsaalfleksioon provotseerib n\u00e4rvikoe venitumist. Kuna sirutatud p\u00f5lveliigese korral suureneb istmikun\u00e4rvi venitus, siis testiaegne lihasn\u00f5rkus v\u00f5ib olla tingitud valust mitte testi ajal avalduvast survest n\u00e4rvijuurele. N\u00e4iteks v\u00f5ib L3 ja L4 n\u00e4rvijuure patoloogiat ning reie nelipealihase n\u00f5rkust hinnata funktsionaalselt \u00fchel jalal istumast seisma t\u00f5usmise testiga, sealjuures v\u00f5ib patsient tasakaalu s\u00e4ilitamiseks toetuda terapeudi k\u00e4tele.<\/span>\n<\/p>\n

\n\tKui patsiendil esineb \u00e4\u00e4rmiselt suur valu, siis teostada esmalt k\u00f5ik hindamised patsiendi seliliasendis, seej\u00e4rel k\u00f5huliasendis. See v\u00e4hendab hindamisega seotud vajalike liigutuste hulka ning patsiendi ebamugavustunnet. Joonisel 9 on n\u00e4idatud asendid ja v\u00f5tted alakeha m\u00fcotoomide hindamisel.\u00a0 <\/span>\n<\/p>\n

\n\t
Tabel 5. L\u00fclisamba nimmeosa n\u00e4rvijuurte s\u00fcndroomid.<\/span>
\n<\/h5>\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

\n\t\t\t\t\tN\u00e4rvi<\/span><\/span><\/span><\/b><\/span>juur<\/span><\/span><\/span><\/b><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tDermatoom<\/span><\/span><\/span><\/b><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tLihasn\u00f5rkus<\/span><\/span><\/span><\/b><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tParesteesia<\/span><\/span><\/span><\/b><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tL1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tSelg, reieluu suure p\u00f6\u00f6rla ja kubemepiirkond<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tPuudub<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tKubemepiirkond nt istumisel<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tL2<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tSelg, reie eesmine piirkond kuni p\u00f5lveliigeseni<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm psoas, puusaliigese l\u00e4hendajad<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tAeg-ajalt reie eesmine piirkond<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tL3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tSelg, tuhara \u00fclemine osa, reie eesmine piirkond ning p\u00f5lveliiges, alaj\u00e4seme mediaalne osa<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm psoas, m quadriceps<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tP\u00f5lveliigese sisemine ning alaj\u00e4seme anterioorne piirkond<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tL4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tTuhara sisemine piirkond, reie v\u00e4limine piirkond, alaj\u00e4seme sisemine piirkond, labajala selgmine piirkond, suur varvas<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm tibialis anterior, m extensor hallucis<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tS\u00e4\u00e4re ja h\u00fcppeliigese sisemine piirkond<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tL5<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tTuhar, reie tagumine ja v\u00e4limine piirkond, labajala selgmine piirkond, talla sisemine piirkond, esimene, teine ja kolmas varvas<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm extensor hallucis, m peroneus, m gluteus medius, hamstringlihased, m tibialis anterior<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tAlaj\u00e4seme lateraalne piirkond, keskmiselt kolm varvast<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tS1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tTuhar, reie tagumine piirkond, alaj\u00e4se<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tS\u00e4\u00e4r ja hamstringlihased, tuharalihased, peroneaallihased, talla painutajalihased<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tLateraalselt kaks varvast, labajalg ning alaj\u00e4se kuni p\u00f5lveliigeseni, labajala taldmine osa<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tS2<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tSama, mis S1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tSama, mis S1 va peroneaallihased<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tAlaj\u00e4seme lateraalne piirkond, p\u00f5lveliiges, kand<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tS3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tKubemepiirkond, reie sisemine piirkond p\u00f5lveliigeseni<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tPuudub<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tPuudub<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tS4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tLahkliha, genitaalpiirkond, ristluu alumine piirkond<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tKusep\u00f5is, p\u00e4rasool<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tSadulapiirkond, genitaalpiirkond, p\u00e4rakupiirkond, impotentsus<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\n\t\u00a0Tabel 6. Alaj\u00e4seme m\u00fcotoomid.<\/span><\/span><\/span>
\n<\/h5>\n\n\n\n\n\n\n\n\n\n\n
\n

\n\t\t\t\t\tN\u00e4rvi<\/span><\/span><\/span><\/b><\/span>juur<\/span><\/span><\/span><\/b><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tFunktsioon<\/span><\/span><\/span><\/b><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tLihased<\/span><\/span><\/span><\/b><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tL1-L2<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tPuusaliigese painutus<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm psoas, m iliacus, m sartorius, m gracilis, m pectineus, m adductor longus et brevis<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tL3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tP\u00f5lveliigese sirutus<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm quardiceps femoris, m adductor longus,magnus et brevis<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tL4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tH\u00fcppeliigese dorsaalfleksioon<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm tibialis anterior et posterior, m quadriceps femoris, m tensor fasciae latae, m adductor magnus, m obturator externus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tL5<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tSuure varba sirutus<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm extensor halluxis longus, m extensor digitorum longus, m gluteus medius et minimus, m obturator internus, m semimembranosus, m semitendinosus, m peroneus tertius, m popliteus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tS1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tH\u00fcppeliigese plantaarfleksioon<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n

\n\t\t\t\t\tH\u00fcppeliigese eversioon<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n

\n\t\t\t\t\tPuusaliigese sirutus<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n

\n\t\t\t\t\tP\u00f5lveliigese painutus<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm gastrocnemius, m soleus, m gluteus maximus, m obturator internus, m piriformis, m biceps femoris, m semitendinosus, m popliteus, m peroneus longus et brevis, m extensor digitorum brevis<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tS2<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tP\u00f5lveliigese painutus<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm biceps femoris, m piriformis, m soleus, m gastrocnemius, m flexor digitorum longus, m flexor halluxis, metatarsaalluude vahelised lihased<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tS3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\t\u2013<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tmetatarsaalluude vahelised lihased (<\/span><\/span><\/span><\/i>va m abductor hallucis), m flexor hallucis brevis, flexor digitorum brevis, m extensor digitorum brevis<\/i><\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\n\t\"Joonis\n<\/p>\n

\n\tJoonis 9. Asendid ja v\u00f5tted alakeha m\u00fcotoomide hindamisel. A \u2013 puusaliigese painutus (l2), B -p\u00f5lveliigese sirutus (l3), C -h\u00fcppeliigese dorsaalfleksioon (l4), D \u2013 h\u00fcppeliigese eversioon (s1), E -suure varba sirutus (l5).<\/span>
\n<\/h5>\n","protected":false},"excerpt":{"rendered":"

Perifeersete liigeste hindamise j\u00e4rgselt hindab terapeut patsiendi lihasj\u00f5udu v\u00f5imaliku neuroloogilise n\u00f5rkuse tuvastamiseks (tabel 5). Iga m\u00fcotoomi eraldi hinnates asetatakse liiges kas neutraal- v\u00f5i puhkeasendisse, misj\u00e4rel avaldab terapeut vastavale liigutusele isomeetrilist vastupanu (tabel 6). V\u00f5imaliku lihasn\u00f5rkuse tuvastamiseks peab lihaskontraktsiooni s\u00e4ilitama v\u00e4hemalt …<\/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-65","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages\/65","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=65"}],"version-history":[{"count":1,"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages\/65\/revisions"}],"predecessor-version":[{"id":548,"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages\/65\/revisions\/548"}],"wp:attachment":[{"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/media?parent=65"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}