The method of determining the functional relationships of paired muscles of the hand

 

(57) Abstract:

The invention relates to medicine and is intended to determine the functional relationship of paired muscles of the hand. Register the original reflex muscle tone of the right shoulder and forearm followed by registration reflex tonus of muscles of the right forearm in flexion and extension of the left hand, then record the original reflex muscle tone of the left shoulder and arm with the subsequent registration of reflex muscle tone of the left forearm in flexion and extension of the right hand. Calculate the percentage of reflex muscle tone forearms to the original reflex contraction of the muscles of the forearms and changes in functional tests determine the functional conjugation muscles. The method allows to detect the decrease in reflex tone denervated muscle groups in patients with damaged nerves in relation to the muscles “intact” hands. 3 table.

The invention relates to pathological physiology, neurophysiology, functional diagnostics and can be used for diagnostics of the functional connections between muscles in the preoperative and postoperative periods for generation t is tsionaljnogo relationship of paired muscles during exercise.

A well-known regularity of the function of the antagonistic muscles, according to which in the exercise flexor (extensor) of one limb reflex relaxes muscles-flexors (the muscles extensor) symmetrical muscles on the other limb (Vvedensky N. B. Ukhtomsky A. A. Physiological journal of the USSR, I. 49, No. 4, S. 449, 1963).

There is a method of determining the elasticity of striated muscle antagonists (Tkachev C. M. Subordination changes in the elasticity of striated muscle in different functional States of the Central nervous system. Diss. K. B. N. L., 1948).

The disadvantage of this method is the lack of determination of the functional relationship of paired muscles.

There is a method of determining cross (paired) braking flexion reflex by measuring the electrical activity of segmental insertion of neurons in the experiment (Motsnyi, P. E., Bakalova R. P. On the role of segmental insertion of neurons in the cross-inhibition of the flexor reflex. Physiological journal of the USSR, I. 53, S. 1354, 1967).

The disadvantage of this method is its invasiveness in connection with the use of supra the shoulder in children by measuring electrical activity twin peak and triceps muscles of the shoulder (Soderstrom B. I. The relationship between the antagonists. Physiological journal of the USSR, I. 50, 725 S., 1965).

The disadvantage of this method is the lack of definition of the cross (paired) relationship for symmetric shoulder in flexion and extension of the shoulder.

There is a method of determining asymmetry excitability of muscles in patients with unilateral damage to the brachial plexus, which identified anticipatory loss of excitability of the muscles of the left hand when damage to the nerve trunks of the left brachial plexus (Nikulin C. A., T. Tyszkiewicz, the Asymmetry of elektrovojvodina muscle damage of the right and left brachial plexus. // Journal of neurology and psychiatry. S. S. Korsakov - No. 10, S. 66, 1988).

The disadvantage of this method is the lack of determination of the functional relationship of paired muscles of the hand.

Closest to the claimed method is a method of determining the functional relationships of paired muscles by registering electromyograms (Saharans Y. H. Electromyographic analysis of muscle at different loads and speeds of movement. Physiological journal of the USSR. I. M. Sechenov so 50, No. 6, 1964, 716-726).

Nedostatek reflex muscle tone.

The invention is directed to a method that provides the definition of the functional relationships of paired muscles of the hands in patients with damage to the nerve trunks of the brachial plexus and in healthy people.

The method consists in successive registration reflex tonus of muscles of shoulder and upper arm and carrying out functional tests (flexion and extension of the symmetric brush.

The inventive method differs from the prototype in that register outbound reflex muscle tone of the right shoulder and forearm followed by registration reflex tonus of muscles of the right forearm in flexion and extension of the left hand, then record the original reflex muscle tone of the left shoulder and arm with the subsequent registration of reflex muscle tone of the left forearm in flexion and extension of the right hand and calculate the percentage of reflex muscle tone forearms and change reflex muscle tone forearms functional probes determine the functional conjugation muscles.

The proposed method is implemented as follows. The patient is seated before the table, offer him to put his hands on the table to be treated. Put on the shoulder, then on the forearm cuff, combine it with mechanicallyoperated include automatic air in the cuff at a rate of 3 mm RT.art./with an up-level the age limit of systolic blood pressure and achieving this level of track on the scoreboard mechanotherapy, then include decompression of the cuff, while the register and decompression curve (patent RF №2135073). The slope of the curve decompression with respect to the horizontal reference line represents the speed of decompression of the cuff. Then record the same way the original theostearroma and line decompression on the forearm, repeat the recording again when bending and straightening of the left hand, as it causes reflex on stretching the muscles of both arms - one of them blow a jet of air at the shootout decompression of the cuff, on the second floor when bending and straightening brush, forming a cross, counter reflexes. In subsequent produce original registration theostearroma on the left shoulder and forearm, just repeating the alternate recording of the forearm while bending (extension) of the right hand. Calculation reflex tone produced by the formula:

where T - reflexive tone proven reference HELL;

t - time decompression of the cuff in seconds measured from the start of the decompression of the cuff until the moment of crossing the line decompression with baseline HELL.

The method allows to determine the functional relationship of paired muscles of the hands of the largest changes in reflex tonus damaged and intact” hands in the induction of reflex tone simultaneously with both hands, one of which in turn produce the registration activity of the tissues (muscle tone) with simultaneous flexion or extension of the brush on balanced hand. Emerging counter bilateral cross-reflexes allow you to identify the reduction of reflex tone denervated muscle groups in patients with damaged nerves in relation to the muscles “intact” hands and compared with values in the group of healthy individuals. The inventive method is developed and clinically tested in the Polenov research neurosurgical Institute them. Professor A. L. Polenov.

Using the proposed method defined functional relationships of paired muscles of the hand in 6 healthy middle-aged people and in 17 patients with damage to the nerve trunks (table 1).

As shown in t the th and the left forearm is in equilibrium, as a reflex muscle tone arm is no different.

Patients with damage to the median and radial nerves revealed a statistically significant difference: the smaller the magnitude of the reduction of reflex muscle tone of the left forearm in flexion and extension of the right hand is less significant change reflex muscle tone of the left forearm explained by the different influence of the right and left hemispheres. Thus, in recent years, marked by the works of various authors advance the reduction of functional activity of the right hemisphere in the preparation, attitude muscle function to decrease.

This asymmetry changes (D>S) reflex muscle tone of the right and left forearm functional probes is exacerbated if the damage is left radial nerve (line G).

Examples of implementation of the method.

Example 1. Examined the patient P. K. F., 42 years old, healthy right-handed. 10.05.2000 surveyed to determine the functional zaimootnosheniya paired muscles of the right and left hand using the proposed method. The measurement results are presented in table 2.

Note to table 2. In line 1 in the numerator value reflex tone 2 and 3 in the numerator of the percentage reflex tonus of muscles of the forearm to the shoulder, in the denominator to the source of the forearm.

As shown in table 2, the initial reflex muscle tone of the right shoulder more of the left shoulder. The percentage of reflex muscle tone of the right forearm and shoulder in the initial state, more on the right hand, and this rate increases as the bending of the left hand, and by the stretching. In relation to the original reflex contraction of the muscles of the right forearm is almost the same reflex change of tone in flexion and extension of the left hand. This confirms the prevalence (decrease reflex tonus) of the flexors of the right forearm in flexion (increased tone) of the left hand. By straightening the left hand is the reduction of reflex extensor tone of the right hand is associated with mating (re-entry) relationship. Almost the same percentage in flexion and extension of the left hand indicates the absence of weakening transfer reflex influence of paired muscles of the left hand on the right.

Asymmetry changes reflex muscle tone of the left forearm in the initial state and when bending and straightening the right hand explainable currently expertone functional activity of the left structure.

Example 2. Patient B. C. P., 49, and/b No. 2427-99, entered the Polenov research neurosurgical Institute them. Professor A. L. Polenov through 3 years 4 months after injury of the left radial nerve in combination with a fracture of the left shoulder and arm as a result of industrial injury. After orthopedic conservative treatment was delayed recovery of function. To determine the functional relationship of paired muscles of the right and left hand of the patient is examined by using the proposed method, the measurement results are presented below as table 3.

Note to table 3. In line 1 in the numerator the amount of reflex muscle tone shoulder, in the denominator of the forearm and in parenthesis the percentage value of the forearm to the shoulder; in line 2 and 3 in the numerator of the percentage reflex tonus of muscles of the forearm to the shoulder, in the denominator to the source of the forearm.

As shown in table 3, on the right, “intact”, hand the difference reflex muscle tone of the right shoulder and forearm is 62.4 per cent because of the prevalence of reflex muscle tone shoulder. On the left hand in the combined damage of the left radial nerve and fracture of the left shoulder and forearm reduced reflex t is ri flexion of the left hand there is no transfer (conjugate of change) of the muscle tone of the right forearm. By straightening the left hand there is a change in reflex tonus of muscles of the right forearm 14.8% (177,2-162,4), and by straightening the right hand change reflex muscle tone of the left forearm is 4.5% (112,9-108,4). These changes indicate a violation of the functional relationships of paired muscles of the right and left hand.

The method of determining the functional relationships of paired muscles of the hand by registering muscle function, wherein the source register reflex muscle tone of the right shoulder and forearm followed by registration reflex tonus of muscles of the right forearm in flexion and extension of the left hand, then record the original reflex muscle tone of the left shoulder and arm with the subsequent registration of reflex muscle tone of the left forearm in flexion and extension of the right hand and calculate the percentage of reflex muscle tone forearms to the original reflex contraction of the muscles of the forearms and changes in functional tests determine the functional conjugation muscles.



 

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