Kovac C, Krapf M, Ettlin T, Mennet P, Stratz T, Müller W
Hochrhein-Institut für Rheumaforschung und Rheumaprävention, Bad Säckingen (D)/Rheinfelden CH.
Z Rheumatol. 1994 Jan-Feb;53(1):26-36.
Muscular spasm is a frequent symptom which is difficult to record precisely. On the basis of literature on the subject and of own studies, we undertook to describe various methods of examination which could be used to demonstrate such changes. Up to now, palpation is still the most important and most exact method for the experienced examiner. In this way local as well as extended muscular spasms can be made evident. The disadvantage however is the lack of objective proof. The easy-to-use Tissue-Compliance-Meter of Fischer, which measures the consistency of soft tissue, documents the intraindividual difference rather than the interindividual difference. This is due to the individually variable thickness of the subcutaneous fatty tissue. However, on the whole there is a good correlation to the findings of palpation. The pendulous-test and badismography allow especially the conclusion with regard to unilateral changes of tonus in the gluteal and upper leg muscles. This method also very well suits the intraindividual comparison, but less so the interindividual one. The continuous electromyogram is able to show the enhanced activity in spasmotic muscles also during sleep. The evaluation of enhanced muscle activity remains uncertain when using plain electromyogram. Recording of muscle tissue oxygen pressure is of little use to evaluate muscle spasm. Nonetheless, it provides interesting insights into pathogenetic questions. Thermography, measuring the blood circulation at the skin surface, is especially suited for perceiving intraindividual differences in case of muscle spasm. Nuclear magnetic resonance spectroscopy allows for noninvasive pH measurements in the muscle and therewith renders certain data concerning the degree of tension of this tissue. It is not yet suited for routine examination. The value of positron emission tomography for registering muscle spasm remains uncertain. Hopefully, this method, which documents the muscle energy metabolism, will enable us to more clearly evaluate muscle spasm than previous methods have done. Light and electron microscopic studies have provided contradictory results concerning histological changes in muscle biopsy in case of muscle spasm.
肌肉痉挛是一种常见症状，难以精确记录。基于关于该主题的文献和我们自己的研究，我们着手描述可用于证明此类变化的各种检查方法。到目前为止，触诊对于有经验的检查者来说仍然是最重要、最精确的方法。通过这种方式，局部以及广泛性肌肉痉挛都可以显现出来。然而，缺点是缺乏客观证据。费舍尔易于使用的组织顺应性测量仪，用于测量软组织的韧性，记录的是个体内差异而非个体间差异。这是由于皮下脂肪组织厚度的个体差异所致。然而，总体而言，它与触诊结果有良好的相关性。摆锤试验和摆动描记法尤其有助于推断臀肌和大腿肌肉张力的单侧变化。这种方法也非常适合个体内比较，但不太适合个体间比较。连续肌电图能够显示痉挛肌肉在睡眠期间也有增强的活动。使用普通肌电图时，对增强的肌肉活动的评估仍不确定。记录肌肉组织氧分压对评估肌肉痉挛用处不大。尽管如此，它为发病机制问题提供了有趣的见解。热成像法测量皮肤表面的血液循环，特别适合于察觉肌肉痉挛情况下的个体内差异。核磁共振波谱法可对肌肉进行无创pH测量，从而提供有关该组织张力程度的某些数据。它尚不适合常规检查。正电子发射断层扫描用于记录肌肉痉挛的价值仍不确定。有望这种记录肌肉能量代谢的方法将使我们能够比以往方法更清楚地评估肌肉痉挛。关于肌肉痉挛时肌肉活检的组织学变化，光镜和电镜研究给出了相互矛盾的结果。
