{"id":73,"date":"2024-04-04T05:49:00","date_gmt":"2024-04-04T02:49:00","guid":{"rendered":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/63-aktiivsed-liigutused\/"},"modified":"2024-04-04T05:52:27","modified_gmt":"2024-04-04T02:52:27","slug":"63-aktiivsed-liigutused","status":"publish","type":"page","link":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/63-aktiivsed-liigutused\/","title":{"rendered":"6.3. Aktiivsed liigutused"},"content":{"rendered":"

\n\tErinevalt teistest perifeersetest liigestest, ei ole SI-liigeste funktsioone otseselt kontrollivaid lihaseid. Siiski tuleb hinnata teiste liigeste funktsioonide eest vastutavaid lihaseid, kas aktiivsete v\u00f5i vastupanuga teostatud isomeetriliste testidega, sest vastavad lihased avaldavad oma funktsioonidega survet SI-liigesele. Tabelis 1 on toodud lihased, mis kinnituvad vaagnale.<\/span>\n<\/p>\n

\n\t\u00a0
Tabel 1. Vaagnale kinnituvad lihased.<\/span><\/span><\/span>
\n<\/h5>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
\n

\n\t\t\t\t\tm latissimus dorsi<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tC6-C8<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm obturatorius internus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5,S1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm erector spinae<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL1-L3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm obturatorius externus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL3,L4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tmultifidius<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL1-L5<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm piriformis<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5, S1-S2<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm external oblique<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tT7-T12<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm inferior gemellus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5,S1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm internal oblique<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tT7-T12, L1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm superior gemellus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5,S1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm transversus abdominis<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tT7-T12, L1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm pectineus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL2,L3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm rectus abdominis<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tT6-T12<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm semimembranosus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5, S1-S2<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm pyramidalis<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tT12<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm semitendinosus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5, S1-S2<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm quadratus lumborum<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tT12, L1-L4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm biceps femoris<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5, S1-S2<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm psoas minor<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\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\tm tensor fascia latae<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL4-L5<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm iliacus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL2-L3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm sartorius<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL2-L3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm levator ani<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\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\tm rectus femoris<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL2-L4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm sphincter ani externus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tS2-S4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm gracilis<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL2-L3<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm coccygeus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tS4-S5<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm adductor magnus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL2-L4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm gluteus maximus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5, S1-S2<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm adductor longus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL2-L4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm gluteus medius<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5,S1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tm adductor brevis<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL2-L4<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n

\n

\n\t\t\t\t\tm gluteus minimus<\/span><\/span><\/span><\/i><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

\n\t\t\t\t\tL5,S1<\/span><\/span><\/span><\/span>\n\t\t\t\t<\/p>\n<\/td>\n

\n

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

\n

\n\t\t\t\t\t\u00a0<\/span>\n\t\t\t\t<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

\n\tSakroiliakaalliigeste funktsioone hinnatakse aktiivselt l\u00fclisamba v\u00f5i puusaliigese liigutusi teostades.
\n<\/h6>\n

\n\tN\u00e4iteks v\u00f5ib vastupanuga teostatud puusaliigese abduktsioon p\u00f5hjustada SI-liigese d\u00fcsfunktsiooni korral valu sama kehapoole SI-liigese piirkonnas, sest m gluteus mediuse<\/i> tugeva kontraktsiooni korral t\u00f5mmatakse niudeluu ristluust eemale. Kere k\u00fclgpainutus <\/span>avaldab suuremat nihkekoormust sama kehapoole SI-liigesele. Erinevate liigutuslike testide eesm\u00e4rk on provotseerida SI- liigeste d\u00fcsfunktsiooniga seotud s\u00fcmptome.\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/span>\n<\/p>\n

\n\tVaagna aktiivsete liigutuste ajal hindab terapeut ebas\u00fcmmeetrilisi liigutusi, liigutuste h\u00fcpo- v\u00f5i h\u00fcpermobiilsust, kudede kontraktsiooni ja palpatoorset tundlikkust v\u00f5i p\u00f5letikku. Teadma peab, et k\u00f5ikides suundades teostatud nii l\u00fclisamba liigutused (fleksioon, ekstensioon, lateraalfleksioon, rotatsioon) kui puusaliigese liigutused (fleksioon, ekstensioon, abduktsioon, adduktsioon, v\u00e4lis- ja siserotatsioon) avaldavad survet SI-liigestele. Vaatamata sellele, et vaagnapiirkonna patoloogiat saab tuvastada mitmete l\u00fclisamba ja puusaliigese aktiivsete liigutuste testidega, on allj\u00e4rgnevalt kirjeldatud \u00fcht aktiivse liigutuse testi, mis teostatakse l\u00fclisamba ja teist puusaliigese aktiivse liigutuse osalusel.\u00a0 <\/span>\n<\/p>\n

\n\tRistluu fleksioontest
\n<\/h4>\n
\n\tAktiivsel selja sirutamisel ei toimu vaagna- ja ristluu liikumist.
\n<\/h6>\n

\n\tL\u00fclisamba tahasirutuseks seisab patsient nii, et tema keharaskus on jaotatud v\u00f5rdselt m\u00f5lemale alaj\u00e4semele. Terapeut istub toolil patsiendi selja taga ning palpeerib tema m\u00f5lemad PSISed (joonis 1B). Patsiendil palutakse teostada l\u00fclisamba sirutus kuni terapeut m\u00e4rkab liigutuslikku as\u00fcmmeetriat. Normaalsel juhul liiguvad PSISed selja sirutuse ajal v\u00e4hesel m\u00e4\u00e4ral alumisele (ingl inferiorly<\/i>). Taha sirutamise ajal j\u00e4\u00e4vad nii vaagnaluud kui ristluu <\/span>samasse asendisse, nendevahelist liikumist ei toimu. Seej\u00e4rel palpeerib terapeut bilateraalselt ristluu S1 tasandil. Kui patsient sirutab selja, liigub ristluu normaalsel juhul ette.<\/span>\n<\/p>\n

\n\tGillet test
\n<\/h4>\n
\n\tGillet test v\u00f5imaldab tuvastada sakroiliakaalliigese h\u00fcpomobiilsuse.
\n<\/h6>\n

\n\tSI-liigese patoloogia m\u00f5jutab ka puusaliigese liikuvust. Kui patsient painutab seistes vahelduvalt kummagi alaj\u00e4seme puusaliigesest, hindab terapeut puusaliigese liikuvust, valu esinemist ning PSISe liikuvust. Enne kui patsient painutab alaj\u00e4seme puusaliigesest hindab terapeut bilateraalselt PSISte s\u00fcmmeetrilisust. Normaalsel juhul, kui patsient painutab alaj\u00e4seme puusa- ja p\u00f5lveliigesest 90\u00b0 ja rohkemgi, liigub sama kehapoole SI-liiges\u00a0<\/span>kaudaalsele (alla) teise kehapoole SI-liigese suhtes. Kui SI-liigese liikumist allasuunas ei toimu, v\u00f5ib leid viidata alaj\u00e4seme painutuse sooritanud kehapoole SI-liigese h\u00fcpomobiilsusele.<\/span>\n<\/p>\n

\n\tTerapeut v\u00f5ib hinnata vastavat liigutust nii, et tema \u00fcks p\u00f6ial on PSISel, teine p\u00f6ial S2 ristij\u00e4tkel (joonis 2A). Normaalse SI-liigese liikuvuse korral PSISel olev p\u00f6ial liigub allasuunas (joonis 2B). Kui SI-liiges on h\u00fcpomobiilne, liigub p\u00f6ial puusaliigese painutusel \u00fcles. SI-liigese funktsionaalsust hinnatakse m\u00f5lemal kehapoolel.<\/span>\n<\/p>\n

\n\tTest j\u00e4tkub kui terapeut j\u00e4tab \u00fche p\u00f6idla ristluu ogaj\u00e4tkele ning asetab teise istmikuluu k\u00f6brule (joonis 2C). Patsiendil palutakse painutada puusaliiges nii kaugele kui v\u00f5imalik. Normaalsel juhul liigub istmikuluu k\u00f6brul olev p\u00f6ial lateraalsele (joonis 2D). H\u00fcpomobiilse SI-liigese korral liigub terapeudi p\u00f6ial kraniaalselele (\u00fcles). Sama korratakse teisel kehapoolel. <\/span>\n<\/p>\n

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

\n\tJoonis 2. Gillet test. A \u2013 algasend \u2012 ristluu ja psisise palpatsioon; B \u2013 puusaliigese painutus; C \u2013\u00a0 algasend \u2012 ristluu ja istmikuluu palpatsioon; D \u2013 puusaliigese painutus.<\/span>
\n<\/h5>\n","protected":false},"excerpt":{"rendered":"

Erinevalt teistest perifeersetest liigestest, ei ole SI-liigeste funktsioone otseselt kontrollivaid lihaseid. Siiski tuleb hinnata teiste liigeste funktsioonide eest vastutavaid lihaseid, kas aktiivsete v\u00f5i vastupanuga teostatud isomeetriliste testidega, sest vastavad lihased avaldavad oma funktsioonidega survet SI-liigesele. Tabelis 1 on toodud lihased, …<\/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-73","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages\/73","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=73"}],"version-history":[{"count":1,"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages\/73\/revisions"}],"predecessor-version":[{"id":540,"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/pages\/73\/revisions\/540"}],"wp:attachment":[{"href":"https:\/\/sisu.ut.ee\/fysioterapeutilinehindamine\/wp-json\/wp\/v2\/media?parent=73"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}