The authors give the schema of the different zones of the body and their points of measuring. They report on some average values registered with Szirmai's myotonometer on persons before and after massage. These myotonometric
schemas play a new and important part in systematic measuring of muscles in the field of &#34;Myologia practica&#34;.</p

Juranyi, Robert

Szirmai, Endre

Okayama University Scientific Achievement Repository

Acta Medica OkayamaVolume 16, Issue 2 1962 Article 1APRIL 1962Myological Tonus-contraction Schema ofMyotono-Metric Zones of the Body BeforeMassageEndre Szirmai∗ Robert Juranyi†∗Aus dem Gerinnungsphysiologischen,†Praktischen Muskelunters Laboratorium,Copyright c©1999 OKAYAMA UNIVERSITY MEDICAL SCHOOL. All rights reserved.Myological Tonus-contraction Schema ofMyotono-Metric Zones of the Body BeforeMassage∗Endre Szirmai and Robert JuranyiAbstractThe authors give the schema of the different zones of the body and their points of measuring.They report on some average values registered with Szirmai’s myotonometer on persons beforeand after massage. These myotonometric schemas play a new and important part in systematicmeasuring of muscles in the field of “Myologia practica”.∗Copyright c©OKAYAMA UNIVERSITY MEDICAL SCHOOLActa Med. Okayama 16, 61-70 (1962)MYOLOGICAL TONUS-CONTRACTION SCHEMA OF MYOTONO·METRIC ZONES OF THE BODY BEFORE MASSAGEEndre SZIRMAI and Robert JURANYI*Aus dem Gerinnungsphysiologischen und Praktischen MuskeluntersLaboratorium, Bundapest, IV. Arpad-ut 124, Ungarn und Z. zt.Stuttgart- W, Klopstockstr. l.B. R. DeutschlandReceived for publication, December 12, 1961Since the construction of the myotonometer and the myograph by SZIRMAI,and since determination' of the principles of myotonometry and myography,a great number of publications (SZIRMAI3 \ JURANYI5, HABERL6, BAJUSZ,BOLLOBAS8, PREZDPELSKA-KocZOCIK9, etc.) confirmed the "Myologia Practica" tobe a great progress in medical and veterinary fields. A wide scope of possibilitiesis opened up by myotonometry and myography, respective examinations of thetransversal muscles, of the elemetary substances and consequently also of thecapillaries of the joints and nerves. They further constitute a means for evaluat-ing the healing effect of medicaments. As previously stated, both of the abovebiophysic proceedings are based upon measuring voluminal changes in substancesand transversal muscles.Serial measurements made setting up a measuring system necessary. Thissystem comprises working out schema of the different parts of the body and inthe first place fixing the particular spots on the body to be measured, consideringalso constitutional differences.In 1953 SZiRMAIll worked out the schema of the abdomen, publishedin 1955 with the purpose of registering abdominal sensitivity to pain and inorder to give a uniform method of registration of abdominal processes. Casesof various diseases have shovm since that the simplest way of registering was tofollow a schema. A uniform examination method can thus be realized within asingle ward as well as in any kind of institution. This is so even though, in thecase of persons of different constitution and nutrition (profession), there mightbe slight divergencies in the registered points: either the abdominal muscle isrounded to the highest degree, or there is a displacement of the part, whichrespective registration process, should prove best.VVith regard to diagnostic, prognostic and other respects in order to registersingle parts of the body, we worked out a schema of the following parts of thebody, of which we made some sketches indicating the most favourable pointsof measurements.611Szirmai and Juranyi: Myological Tonus-contraction Schema of Myotono-Metric Zones ofProduced by The Berkeley Electronic Press, 196262 E. SZIRMAI and R. JURANYIFig. 1. Schema for head and neck registration. Experience proves thatwe are able to register the masseter and the sternomastoideus. In the case ofcertain professions, e. g. wrestlers, we can register the platysma. In 1951 al-ready, SZIRMAI described the possibility of registering the muscles of the neckwith the myograph.Fig. 2. The muscles of the shoulders and of the upper arms. Both can beregistered, the most important measuring spots are marked.Fig. 3. The flexor muscle of the upper arms.Fig. 4. The tendon muscle of the forearms.Fig. 5. The flexor muscle of the forearms and of the hand.Fig. 6. The flexor of the thigh.Fig. 7. The tendon muscle of the thigh.Fig. 8. The flexor of the leg.Fig. 9. The tendon muscle of the leg.TABLE 1. Values of the stimulus threshold of sensibility to pain measuredon healthy persons, a, on patients with appendicitis, b,subacute adnexitis, c and with ulcus ventriculi. +Point of measurementIGramm-myotons resp.Gramm-values of pressure1. McBurney-point a b c d2. 5 cm to left of Spina iliaca anterior supelior, Szirmai 34 2 11 5 193. KUmmell-point 30 12 23 0 214. 3 cm to left of Lenzmann-point 30 8 20 8 205. 3 cm under the contra-Lenzmann point 34 4 15 0 206. 3 cm under KUmmell-point 31 - 21 8 -7. 5 cm under KUmmell-point 28 21 - 8 -8. Between navel and processus xiphoideus OIl the border- - - - - 19line of the upper and the middle third 37 - 25 15 189. Between navel and processus xiphoideus on the border- - - 18 4 10line of the middle and the lower third10. Between the right costal region and the navel on the 28 - 22 14 23border-line of the upper and the middle third11. Between the right costal region and the navel on the 28 - 15 5 25border-line of the upper and the middle third12. Between the left costal region and the navel on the 28 - 27 10 18border-line of the upper and the middle third13. Between the left costal region and the navel on the 28 - 16 12 14border-line of the middle and the lower thirdI14. In the height of the navel in the middle to the right 30 - 20I14 15I15. In the height of the navel in the middle to the right 34 - 20 5 15I+ E. Szirmai: Zbl. f. Chirurgie 1956. H.14.2Acta Medica Okayama, Vol. 16 [1962], Iss. 2, Art. 1http://escholarship.lib.okayama-u.ac.jp/amo/vol16/iss2/1Myological Tonus-Contraction SchemaTABLE 2. The standard values of tonus-contraction measurements atlight straining of the spring63Name of the muscleITonus Contractionin MyotonsM. masseter 90 100M. sternocleidom~stoideus 80 102M. trapezius 78 83M. deltoideus 75 78M. triceps caput lat. 80 98M. caput brevis m. bicipiti 70 90M. ext. carpi rad. long. 1./ 94 1082./ 94 112M. interossei dorsales digit. I. 72 124M. extensor carpi rad. 90 110Tendon m. flexor carp. rad. 70 100M. biceps femoris 90 112M. vastus lat. 90 120M. vastus med. 70 90M. rectus femoris 80 94M. sartorius 82 104M. gastrocnemius 84 10286 106M. soleus 82 102Tendon calc. achillis 90 114M. tibialis ant. 120 135M. peroneus long. 90 112M. pectoralis major 70 90M. latissimus dorsi 74 96Our starting value is 50 myotons, 1 myoton 1mm. This value may be reduced from thetotal value measured. We count total values measured, e. g. for M. pectoralis major 70 myo-tons, and net values, i. e. starting value reduced from the total value measured, e. g. 70-50=201.Fig. 10. The schema of the abdomen, published by Szirmai in 1956.Fig. 11. Schema of the chest.Fig. 12. Schema of the back.The schema of the abdomen shows numbers put into brackets, markingthe sequence of measurements, c. g. 1 McBumey-point: this number 1 meansthat measurements start at this point. Here we may observe that there are twoways of registering abdominal sensitivity to pain:1. We may charge the abdominal wall with the net weight of the apparatussimply by laying it on. Herewith we register the upper parietal layers, we call3Szirmai and Juranyi: Myological Tonus-contraction Schema of Myotono-Metric Zones ofProduced by The Berkeley Electronic Press, 196264 E. SZIRMAI and R. ]URANYIM. splenius capt/is -....+4lr-M. lera/or scQpul(U-~:::5Mo scalenus pD$lerior·---3......~M.lrapilsius ....,.cliM de/lDidet/s---,~I~_- N. my/ohyo;deu,AI. omohyoidl'lJ.sId. fh!JIPohyoideu.s. slernolhVfl1Qid"I/sClavictdaFig. 1. Head and neck. 1. M. masseter. 2. M. sternocleidomastoideus. 3. M.trapezius of strong-muscled person. Besides above 3 muscles, we may register thecontraction of the platysma on the surface and that of:almost~all~musclesperceivableon the sketch.ClaviculaAf.lI.r!Msorcarpirad./on9·Af. e,flllnSOr &9/1. comm.A? l1.r!l1nsor carpi raa. 6revAt. inlra$p;na-;;;;,!4..;;;.;'lIs:.....,.~w;lA. /lIrt's minor'_-'~~~~At. leres major. __"'~iIii'"M./riceps h_..;.,.,.-a.-ch.;,;,i;..~· -'==....:.::.~~I¥+)OlecranonM ancon·aeU$M. ~.dllnsor carpiu/n.M. flnor carpi u/nari6Fig. 2. Tendon of the shoulders a'nd the arms. 1. M. deltoideus. 2. M. tricepscaput lat.the procedure: parietal measuring.2. In addition to the net weight of the apparatus a pressure is brought tobear on the abdominal wall, thus producing the proper resistance by which wemeasure and register abdominal sensitivity to pain. The oscillation of the indica-tor is to be observed the moment pain sets in.4Acta Medica Okayama, Vol. 16 [1962], Iss. 2, Art. 1http://escholarship.lib.okayama-u.ac.jp/amo/vol16/iss2/1Myological Tonus-Contraction Schema 65We registered the tonus and contraction values. We also made a greatnumber of measurements on healthy as well as on sick persons after massage,because some examinations made by SZIRMAI12 , and published not long ago,Jf. It'fes major'\.:a::~_1rf. /oIissinws dorsiCapvl/ongvm m. bidpi!Js(apulmediale m.lricipilisClaviculaM. coracobrachialisM brach/alis_---.lr.l\Irf hrachioradia/isM. delloidevs__...l11J'M.p~cloralismajor.capuf Ion9vm m.hieipil,.seaptJlbreve m. bicipi/isFig. 3. Flexor of the arm~. 1. Caput brevis m. biceipiti.Itf. fr/ups brach"_'~~'i{,;It1. f'xlf'nsor carp/tJI"At. ~xlf'n$or. dl9if.V. proprltJsAim. inl,rossei dorsalesM. alJdvclor di9i1l1.If. hracltialisAf. bradtioradialisAt. biceps oradlli'Af. e.tl,n50rcarpirad.lon9·AI. nlensordi9il.comm.,'I1"::IIt--tll. nlensorcarpirad.brt'1'.At.abduclorpo/lids /on9ufJAt. nlensorpo/lids DI'PY.At. f',(lensorpollids lon9-Li9.Garpi dorsaJeFig. 4. Tendon of the forearms. 1. bis. 2. M. ext. carpirad. long. 3. M. interossei dorsales digit. T.5Szirmai and Juranyi: Myological Tonus-contraction Schema of Myotono-Metric Zones ofProduced by The Berkeley Electronic Press, 196266 E. SZIRMAI and R. JURANYILacerlus {lbr:tfll'almaris brensAponeurosi6 palmarisItf. /I(lxor carp/rad.ii !f/I/~f..hfir-At. bi(EpS__--lI.....Tendo m. hicipilisIrf. prona/or l£1r'$M. eX/Msor carpiradialis /on9·At. brachiora.dia/is._-Hfj1f!!~,,"At. flexor cU9il,suIJlimisFig. 5. Flexor of the fore-arms.1. M. flexor carp. rad. 2. Tendon muse. flex. carp. rad.M. gll.lleus med.AlpiriformisJrochanler major,If. gemellus s"f't'riorIlia/us /endineusr"iIIIl~-M.plon/orisIf/. gemellus inferiorAf.(/,.uuiralus femorislrf.addtKlor mi"imusA1. fas/us la!.l~...\."l"1"1t--At. 8emi/endinosl.ls: _~~\~~Htlr-Itf. bicEEs femoris- '(capul lon9//m)J/.adduclor magnus,H, semimembranosusLig. sacroluberpslJ/11M. oblu.rallJf in/emusFig. 6. Flexor of the thighs. At bending or, more seldom also atstraining movements. M. biceps femoris and M. vastus lat. are difficultto perceive and thus hard to measure.refer to the fact that certain symptoms may be influenced and pain may bereduced by stimulating circulation and by slight massage of the suffering zones.On upper and lower extremities results can be registered by means of Szirmai's6Acta Medica Okayama, Vol. 16 [1962], Iss. 2, Art. 1http://escholarship.lib.okayama-u.ac.jp/amo/vol16/iss2/1Myological Tonus-Contraction Schema 67myograph. We have demonstrated this in one of our earlier publications.Based upon experiences on several thousand patients and correspondingto our schemata, we have made measurements before massage as well asbefore medicaments were administered. Further examinations are under way.This time we only wish to give a few particulars on these examinations madewith Szirmai's myotonometer before massage, without going into details of theIr1.glula.eus mediusM. reclus femorisMo vas/iLs /al.__~'3Af. addudorlon9t1s.If. 9rad/i.rlfflIt1'fl+- At. sanoriusFig. 7. Tendon of the thighs1. M. vastus med. 2. M. rectus femoris. 3. M. sartorius.Fig. 8. Flexor of the legs.1-2. M. gastrocnemius. 3. M.soleus. 4. Tendon calcaneus achillis. Thismeans really a mechanical transmissionof the movements of the muscles.Irf. goslrocnemius"",>.:....-_M. .ro/ellsAt. flu"rhallucis ion9us7Szirmai and Juranyi: Myological Tonus-contraction Schema of Myotono-Metric Zones ofProduced by The Berkeley Electronic Press, 196268 E. SZIRMAI and R. JURANYIAf.fJ~rO!leV$ /on9u6_-'~.'A'Fig. 9. Extensors of the leg. 1. M.. Tibialis anterior.By sportsman M. peroneus longus too.Fig. 10. Szirmai's schema of theabdomen for measuring the sensibilityto pain. Tonus measurements are onlymade on the surface. Pain is causedby mechanical pressure. The numbersin brackets indicate the sequence ofmeasurements of respeCtive points ofmeasurements demonstrated in detailon Table 1. Numbers not in bracketsindicate values reached in the case ofappendicitis. The punctum maximumin this case is the McBurney pointwhere pain is signaled by the patientalready at a pressure of 4 myotons =4 mm longitudinal pressure of thepivot.8Acta Medica Okayama, Vol. 16 [1962], Iss. 2, Art. 1http://escholarship.lib.okayama-u.ac.jp/amo/vol16/iss2/1Myological Tonus-Contraction SchemaM.,slernocleJdomasloideu..sM. pecloralis major(pars clavJTrigonum delloidRopedoraleMdelloideus ~1~~~~_~,I{. serraJus anI.At. obll't;tUJs aixiominis erlt'rnuJFig. 11. Muscles of the chest. 1-2. M. pectoralis major.69AI. st'mispinalis capAt slernoclt'idomasloideusAI. Irapezius.AI. t,res maj.__~1lII, 1:y/;r4l.U_- Itf. splenius capilisItf. I,ra/or scop._,,,,,,,,,,-_AI. IrapnlusAt. sacrospinalisAt. serralu.sposlinlAI. lallss/mu.s dorsiFascia lumbodor.~-- sa/isFig. 12. Muscles of the back. 1. M. latissimus dorsi. 2. M. trapezius.respective results.In the above figures we have sketched the schema of different parts of thebody. Every sketch presents all particular muscles as well as the average valuesof every measurable point. Where it is needed, signs and abbreviations are usedfor tonus-contraction and maximal amplitude values.We also wish to try to find out what the best way is to register the muscleswith the myotonometer, what their most appropriate state, and their mostsuitable function should be for this purpose.9Szirmai and Juranyi: Myological Tonus-contraction Schema of Myotono-Metric Zones ofProduced by The Berkeley Electronic Press, 196270 E. SZIRMAI and R. ]l.'RANYIAs we stated above our principal aim was to give a description of themyotonometric zones of the body and to give certain demonstrative values oftonus contraction at the points measured. We thus meant to lay down the funda-mental principles of myotonometry. These fundamental aspects and schemataserve as a general guidance for systematic measurements in the fields of phy-siology and pathology as well as in medical and veterinary lines.In our following publications we intend to deal with problems in detail,namely, to discuss the values we abtained at measuring points on different zonesunder morbid or physiologic circumstances and considering certain methods oftreatment, massage, etc. Through this article our only intention was to drawattention to the importance of this schema and to its inevitable problems.SUMMARYThe authors give the schema of the different zones of the body and theirpoints of measuring. They report on some average values registered withSzirmai's myotonometer on persons before and after massage. These myotono-metric schemas play a new and important part in systematic measuring ofmuscles in the field of "Myologia practica".REFERENCES1. SZIRMAI, E.: Zbl. Chir. 77, 49, 19522. Zbl. Chir. 43, 1836, 19533. Arztl. Praxis VIII, 7, 14, 19564. Med. Technik 1, 19565. JURANYI, R.: Zschr. inn. Med. 13, 310, 19586. SZIRMAI-HABERL: Fol. haemat. 75, 2, 19577. BAJUSZ, E.: Zbl. Chir. 78, 1016, 19538. BOLLOBAS, B.: Zschr. inn. Med., 12, 402, 19549. PRZEDPELSKA-KoczOCIK, J.: Przeglad Lekarskiego Krakov, 195810. SZIRMAI, E.: Gynaeocologia, Basel, X, 142, 359, 195611. SZIRMAI, E.: Zbl. Chir. 14. 572, 1955; Acta Med. Okayama, Japan, 1959, 13, 1, 122;Deutsche Med. Wschr. 86, 2228, 196110Acta Medica Okayama, Vol. 16 [1962], Iss. 2, Art. 1http://escholarship.lib.okayama-u.ac.jp/amo/vol16/iss2/1

Myological tonus-contraction schema of myotonometric zones of the body before massage.

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