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PubMedDate not supplied

Simultaneous bilateral testing: validation of a new protocol to detect insincere effort during grip and pinch strength testing.

The detection of feigned weakness in hand grip strength assessment is difficult. The authors review several proposed methods and their weaknesses. A comparison of unilateral testing and simultaneous bilateral testing with the Jamar dynamometer and the Baseline pinch gauge is demonstrated as a solution. An experiment involved 100 asymptomatic subjects who were tested twice, once under instructions to give a full effort and once under instructions to feign weakness. Seven statistical criteria of noncompliance were chosen. Defining noncompliance as failing two or more of the seven criteria, 99% of the instructed noncompliant subjects were correctly classified as noncompliant. No subjects were incorrectly classified as noncompliant during instructed compliant testing. Twelve subjects failed on a single criterion. On retesting, all but one were correctly classified. One subject in the instructed noncompliant group passed all criteria. Accuracy was 99.5%, including retesting of the 12 "gray-zone" subjects.

Adolescent↗
PubMed2002

Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial.

BACKGROUND: Carpal tunnel syndrome is a common condition causing hand pain and numbness. Endoscopic carpal tunnel release has been demonstrated to reduce recovery time, although previous studies have raised concerns about an increased rate of complications. The purpose of this prospective, randomized study was to compare open carpal tunnel release with single-portal endoscopic carpal tunnel release. METHODS: A prospective, randomized, multicenter center study was performed on 192 hands in 147 patients. The open method was performed in ninety-five hands in seventy-two patients, and the endoscopic method was performed in ninety-seven hands in seventy-five patients. All of the patients had clinical signs or symptoms and electrodiagnostic findings consistent with carpal tunnel syndrome and had not responded to, or had refused, nonoperative management. Follow-up evaluations with use of validated outcome instruments and quantitative measurements of grip strength, pinch strength, and hand dexterity were performed at two, four, eight, twelve, twenty-six, and fifty-two weeks after the surgery. Complications were identified. The cost of the procedures and the time until return to work were recorded and compared between the groups. RESULTS: During the first three months after surgery, the patients treated with the endoscopic method had better Carpal Tunnel Syndrome Symptom Severity Scores, better Carpal Tunnel Syndrome Functional Status Scores, and better subjective satisfaction scores. During the first three months after surgery, they also had significantly (p < 0.05) greater grip strength, pinch strength, and hand dexterity. The open technique resulted in greater scar tenderness during the first three months after surgery as well as a longer time until the patients could return to work (median, thirty-eight days compared with eighteen days after the endoscopic release). No technical problems with respect to nerve, tendon, or artery injuries were noted in either group. There was no significant difference in the rate of complications or the cost of surgery between the two groups. CONCLUSION: Good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release is used. Single-portal endoscopic surgery is a safe and effective method of treating carpal tunnel syndrome.

Adult↗
PubMed1995

Physiological reaction and manual performance during work in cold storages.

Subjects were 10 workers (Group R) working in two cold storages (air temperature was between -20 degrees C and -23.2 degrees C), and eight workers (Group C) working in a general storehouse (air temperature was between 12 degrees C and 15.2 degrees C). They were all male workers operating forklift-trucks. Average (SE) age for Group R was 41.4(1.3) years and for Group C was 47.3(1.6) years. Hand tremor, handgrip strength, pinch strength, counting task, flicker value, peak flow rate and blood pressure were measured five times (before work, at 10 a.m., before lunch, at 3 p.m. and after work) per day. Blood samples were collected before lunch. Free fatty acid (FFA) of Group R was significantly higher than that of Group C. There were no significant differences in handgrip strength, pinch strength, counting task, flicker value and peak flow rate between Group R and Group C. However, changes in hand tremor and diastolic blood pressure for Group R were significantly greater than those for Group C. Only for Group R, there was a significant relationship between FFA and the hand tremor values measured the second time. Work loads of Group R would be increased by not only the extreme coldness but also large temperature difference between the inside and the outside of the cold storages. The actual forklift work in these cold storages did not cause a distinct reduction in manual performance, but caused an increase in stress which would be expressed as an increase in catecholamine excretion.

Adaptation, Physiological↗
PubMed1999

Split flexor pollicus longus tendon transfer for stabilization of the thumb interphalangeal joint: a cadaveric and clinical study.

The split flexor pollicus longus (FPL) tendon transfer is a surgical technique using the radial half of the FPL tendon rerouted dorsally and inserted into the extensor pollicis longus tendon for correction of Froment's sign. A cadaveric model was designed to investigate the effects of the split FPL tendon transfer on pinch strength. Pinch strength was compared for extrinsic thumb flexion (1) without the split FPL and (2) with the split FPL, tensioned at 3 different positions (0 degrees flexion, 30 degrees flexion, and 60 degrees flexion). We report the clinical results of key pinch strength using split FPL tendon transfer as part of thumb reconstruction for 12 thumbs in 10 patients at an average follow-up time of 2 years. The cadaveric study showed no significant difference in pinch force between specimens with or without split FPL transfer or when comparing tensioning at 0 degrees versus 30 degrees versus 60 degrees. Froment's sign wa s reproduced in all cadavers with pinch activation without split FPL transfer and was eliminated in all specimens after the split FPL transfer. In the clinical portion of this study 12 transfers in 10 patients had an average follow-up pinch strength of 33.7 N (range, 18-80 N) and no evidence of Froment's sign. We conclude that the split FPL tendon transfer is an effective method for correction of Froment's sign due to intrinsic paralysis of the thumb.

Adult↗
PubMed1981

[Effects on the manual function of men wearing cold-protective clothing to cold stress (author's transl)].

Subjects were exposed in a climatic chamber for 60 min to air temperature at -5 degrees C, -20 degrees C and -30 degrees C wearing cold-protective clothing. The following manual functions were studied as a function of air temperature, upper limb skin temperatures, mean skin temperatures or mean body temperatures: handgrip strength, pinch strength, bolt-removing task and counting task. The decline of skin temperatures was observed during cold exposure, wearing cold-protective clothing. At 60 min of cold exposure to air temperatures at -5 degrees C, -20 degrees C and -30 degrees C, mean skin temperatures were 30.2 degrees C, 27.8 degrees C and 26.5 degrees C respectively, then II-right-finger skin temperatures were 20.7 degrees C, 13.1 degrees C and 11.8 degrees C respectively. There were reductions only on limited number of manual functions as compared with functions under normal conditions, that is, bolt-removing task and handgrip strength did not significantly change during cold exposure, whereas pinch strength and counting task decreased with lower surface temperatures and body temperatures. Body or surface cooling resulted in reductions in pinch strength by the order of 50%. The rising of the body storage index, which was calculated from the change of the mean body temperature, resulted in a linear decrease in counting task. The capacity to perform manual handling task and muscle strength appeared to vary according to the muscle used for these performance and depending on the levels of cold stress. Body cooling, combined with local upper limb cooling, produced the largest performance decrements.

Adult↗
PubMed2006

Relationship of global assessment of change to AUSCAN and pinch and grip strength among individuals with hand osteoarthritis.

OBJECTIVE: This study assessed the utility and construct validity of a new patient global assessment of symptom change for hand osteoarthritis (OA) by examining its associations with change over time in grip strength, pinch strength, and AUStralian CANadian Osteoarthritis Hand Index (AUSCAN). METHODS: Participants (N=531, 80% female, mean age=68) were part of a study on the Genetics of Generalized Osteoarthritis (GOGO) and completed two assessments (average 4 years apart). At the second assessment, participants described change in their right and left hand pain, aching, and stiffness on a 15-point scale with descriptors ranging from "Great deal worse" to "Great deal better". Linear regression models examined associations of global change scores with changes in hand strength and AUSCAN, controlling for age, gender, number of hand joints with OA, and time between assessments. RESULTS: Both right and left hand global assessment of change scores were significantly associated with change in AUSCAN, grip strength, and right hand pinch strength (P<0.05), and approached significance for left hand pinch strength (P=0.06). The strongest associations were between global change scores and AUSCAN change (right hand: beta=0.29, P<0.001; left hand: beta=0.27, P<0.001). Associations of change scores with grip and pinch strength were stronger among participants with greater radiographic OA severity at baseline. CONCLUSION: Results support the validity of this new global assessment of symptom change. This measure is particularly useful for assessing change over time when no baseline data are available. Additional research should examine this measure's responsiveness in the context of clinical trials.

Aged↗
PubMedDate not supplied

An exploratory look at hand strength and hand size among preschoolers.

The purpose of this study was to develop an initial understanding about grip strength, pinch strength and hand size in normally developing 3-, 4-, and 5-year-old children. This study also investigated whether there were relationships among lowing variables: hand strength, hand size, age, and gender. A Jamar dynamometer was used to measure grip strength, and a Jamar pinch gauge was used to measure lateral pinch strength. The study population consisted of 81 preschool children from culturally an economically diverse communities in New York City. Hand strength and hand size were found to increase with each age level. The 5-year-olds were strongest in grip and pinch ability and had larger hands than the 3-year-olds and 4-year-olds. There was no statistically significant difference observed between the boys and the girls or the preferred hand in terms of hand strength.

Child, Preschool↗
PubMed1979

Assessment of past results and current practice in the treatment of rheumatoid metacarpophalangeal joints. Five year review.

A new design of prosthetic finger joint for the rheumatoid patient, and the technique for its insertion is described, which has now been in use for five years. The technique includes the soft tissue correction of the ulnar deviation. Results are reported for all the cases performed in one year giving a two year follow up, assessing flexion strength, pinch strength and the degree of recurrence of ulnar drift associated with loss of pinch strength.

Arthritis, Rheumatoid↗
PubMed2007

Responsiveness of the Michigan Hand Outcomes Questionnaire and physical measurements in outcome studies of distal radius fracture treatment.

PURPOSE: Outcomes study of distal radius fracture (DRF) treatment has been hampered by an uncertainty regarding the most appropriate outcomes assessment tool to evaluate the effectiveness of treatment. This study aimed to measure the responsiveness of the Michigan Hand Outcomes Questionnaire (MHQ) and physical measurements to assess the value of these outcomes tools for DRF studies. METHODS: Forty-seven patients prospectively completed the MHQ and physical testing at 3 months and 6 months (period 1) after open reduction and internal fixation of unstable DRFs. Thirty-seven patients prospectively completed the MHQ and physical testing at 6 months and 1 year after open reduction and internal fixation (period 2). Responsiveness to clinical change within each period was calculated with standardized response means (SRMs). RESULTS: In period 1, all domains of the MHQ except aesthetics significantly improved. The SRMs were large for the overall score and for the work domain. The SRMs were medium for the pain, function, and activities of daily living domains. In period 1, the grip strength, pinch strength, and active wrist range of motion measurements significantly improved and had large SRMs. In period 2, the grip- and pinch-strength tests significantly improved and the SRMs were medium, whereas the active wrist range of motion had a small SRM. CONCLUSIONS: Unlike other conditions such as carpal tunnel syndrome, for which the outcomes questionnaire is the most responsive measure, in DRF treatment both the MHQ and physical tests are responsive in measuring outcomes and should be reported for outcomes studies of DRFs. The MHQ and physical tests can be used for outcomes research related to DRF with the advantage of also being useful for assessing and comparing outcomes for other hand disorders.

Activities of Daily Living↗
PubMed2006

Comparative responsiveness of Japanese versions of the DASH and SF-36 questionnaires and physical measurement to clinical changes after carpal tunnel release.

The purpose of the present study was to test the responsiveness of the Japanese Society for Surgery of the Hand version of the Disability of the Arm, Shoulder and Hand questionnaire (DASH-JSSH) by evaluating effect size (ES) and standardised response mean (SRM) in patients undergoing carpal tunnel release. Subjects comprised 25 patients with carpal tunnel syndrome. All subjects completed the DASH-JSSH, medical outcomes 36-item short-form health survey (SF-36) and visual analogue scale (VAS) for pain and underwent objective assessment of grip strength, pinch strength and static two-point discrimination before and three months after surgery. DASH-JSSH displayed the highest sensitivity to changes at three months, followed by VAS. All subscales of SF-36 were much less sensitive and both grip and pinch strength were unchanged over the three-month period. DASH-JSSH demonstrated more responsiveness to changes after carpal tunnel release than SF-36, VAS and physical measurements, and displayed correlations with subscales of SF-36.

Adult↗
PubMed2004

Effectiveness of constraint-induced movement therapy in chronic stroke patients.

OBJECTIVE: The purpose of this study was to evaluate the effectiveness of constraint-induced movement therapy (CIMT) in dexterity with Action Research Arm Test (ARA test), hand grip strength, pinch strength of affected upper extremity in chronic stroke patients. MATERIAL AND METHOD: An observer-blinded randomized control trial, 69 chronic stroke patients were allocated either to constraint-induced movement technique (n = 33) or conservative treatment (n = 36). The CIMT group received 6 hours of daily affected-upper-extremity training and restrained unaffected upper extremities for 5 days per week, totally 2 weeks. The control group received bimanual-upper-extremity training by conservative neurodevelopmental technique without restrained unaffected upper extremities for 2 weeks. RESULTS: The CIMT group had ARA scores, pinch strength of affected upper extremities statistically significant higher than the control group at p < 0.05, but the hand grip strength had no statistically significant difference, p > 0.05. CONCLUSIONS: CIMT of unaffected upper extremities has an advantage for chronic stroke patients which may be an efficacious technique of improving motor activity and exhibiting learned nonuse.

Adult↗
PubMed1987

Effect of triceps function on the brachioradialis transfer in quadriplegia.

Fifteen patients with traumatic quadriplegia who had transfer of the brachioradialis to the flexor pollicis longus were evaluated to determine the influence of triceps function on pinch strength. Pinch was measured with the elbow free and with the elbow locked at 90 degrees in an orthosis that served as an external means of blocking elbow flexion in those patients with impaired triceps strength. Those patients having two foot-pounds or less elbow extension torque had an average pinch of 1.20 kg without elbow immobilization. With the elbow immobilized, pinch strength increased 153%, averaging 3.04 pounds. Those patients having more than two foot-pounds elbow extension torque had an average pinch of 4.08 pounds with the elbow free and pinch strength was not improved by immobilization in the orthosis. The absence of triceps function significantly decreases the effectiveness of the brachioradialis when used to motor a tendon transfer. Surgical procedures, such as posterior deltoid to triceps transfer, which provide active elbow extension can be expected to significantly increase the pinch strength supplied through the brachioradialis transfer in patients without voluntary elbow extension.

Arm↗