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PubMed1998

Grip strengths and required forces in accessing everyday containers in a normal population.

OBJECTIVE: A commonly adhered to operating principle in occupational therapy clinics is that a person must exhibit 20 lb of grip strength before his or her hand is considered "functional." This study examined the relationship between hand and finger grip performances with the forces required to open common household containers. METHOD: The grip and pinch strengths of 49 college students were obtained using dynamometry. The forces required to open six common household containers were measured using Force Sensing Resistors attached to each container. RESULTS: Weak correlations were found (r = -.179 to r = .333) between grip and pinch strength performances and the forces used to operate the accessing mechanisms of the containers. Analyses of variances demonstrated significantly greater grip and pinch strength performances in men than in women (ps < .05) but no significant difference between the genders in the forces generated to open the containers (ps > .05). CONCLUSIONS: In a normal population of college students, the premise that greater hand strength affords greater performance in accessing everyday household containers was not supported. Implications suggest that grip and pinch dynamometry are not conclusive evaluative tools for predicting hand function while opening a select group of containers. The relationship between traditional dynamometry and hand performance during a variety of functional tasks needs to be examined in clinical populations as well.

Activities of Daily Living↗
PubMed1977

Endoprosthetic replacement of the trapezium for arthrosis in the carpometacarpal joint of the thumb.

One hundred silicone endoprosthetic replacements of the trapezium for arthrosis of the carpometacarpal joint of the thumb (CMC-1 joint) were reviewed in 79 patients with a follow-up time from one to 5 years in 67 women and 12 men. Pre- and postoperatively, pain, range of abduction of the CMC-1 joint, grip and pinch strength were recorded. Pain was relieved in 95 hands and abduction was improved in 85 hands. Dislocation of the endoprosthesis was found in the 15 hands with unimproved abduction. Grip strength was improved in 82 hands and pinch strength in 72 hands. Hyperextension of the metacarpophalangeal joint treated by fusion when more than 20 degrees before operation gave better function than when not fused. Complications were dislocation of the endoprosthesis in 19 hands, one infection, and two fractures of the metacarpal shaft. No fracture of the endoprosthesis itself was observed.

Aged↗
PubMed1992

Carpal arch alteration and related clinical status after endoscopic carpal tunnel release.

One hundred eight endoscopic carpal tunnel releases were performed by a modification of the technique described by Chow. Eighty-seven of the 108 cases were evaluated for quantitative postoperative widening of the transverse carpal arch. The average postoperative widening of the transverse carpal arch was 0.17 cm (7%), with a range of 0 to 0.5 cm. Seventy percent of the patients showed 0% to 10% widening, 26% showed 10% to 20% widening, and 4% showed more than 20% widening of the transverse carpal arch. Preliminary findings show that 3 weeks after endoscopic carpal tunnel release, pinch strength was at 102% and grip strength at 86% of preoperative values. Six weeks after surgery, pinch strength was 106% and grip strength was 121% of preoperative values. The complication rate in this series was 3%. The transverse dimension of the carpal arch generally widens after endoscopic carpal tunnel release but to a lesser degree than has been reported for open carpal tunnel release. The rate of improvement of pinch and grip strength after endoscopic release is faster than that reported in the literature after open release.

Activities of Daily Living↗
PubMed2005

Functional outcome for children with thumb aplasia undergoing pollicization.

BACKGROUND: Hand function is difficult to evaluate in young patients. It is helpful to assess young children after surgery for trauma or congenital anomaly to see how they cope as they progress through their developmental milestones. METHODS: Functional outcome in 10 children (12 upper extremities) who had previous pollicization for a congenitally absent or severely hypoplastic thumb were evaluated by standard radiographs, thumb total active range of motion, grip and pinch strength, parent questionnaire, modified Jebsen functional testing, and a pegboard Functional Dexterity Test. RESULTS: Grip strength was significantly less (p = 0.008) in the hands that had been operated on (mean, 2 kg) compared with the hands that had not been operated on (mean, 5.6 kg). Pinch strength was also significantly less (p = 0.008) in the hands that had been operated on (mean, 1.0 kg) compared with those that had not been operated on (mean, 2.1 kg). In most, hands that had been operated on and those that had not been operated on tested outside the 2-SD range of age-matched normals for pinch and grip strength and also for the Functional Dexterity Test. In contrast, total Jebsen Hand Function Test time was not significantly different from hands that had not been operated on, except that some subtests were significantly different, such as checker stacking (p = 0.016; mean difference, 7.2 seconds) and page turning (p = 0.031; mean difference, -10 seconds). The total active range of motion in hands that had been operated on and those that had not been operated on was also not significantly different. All children used their reconstructed thumbs in a normal pattern. Parent questionnaires revealed satisfaction with appearance and good social interactions. Functional activities showed greatest difficulty handling small objects, especially when simultaneous pinch strength was required, such as fastening buttons and small snaps. CONCLUSIONS: This study demonstrates the importance of evaluating multiple aspects of functional outcome for congenital hand problems and of using comparative age-appropriate validated norms. Pollicization is a rewarding procedure for children with thumb aplasia.

Child↗
PubMedDate not supplied

Evaluation and functional assessment of flexor tendon repair in the hand.

Seventeen patients with 28 flexor tendon injuries were examined after tendon repair. The current most frequently used evaluation systems, including grip and pinch strength, were compared with functional outcome as assessed by a questionnaire, evaluating Disabilities of Arm, Shoulder and Hand (DASH). Good correlation was found between Total Active Motion (TAM) and the Original Strickland test (kappa = 0.85), however with reduced categories. Only limited correlation was found between the DASH-score and TAM (r = -0.33) as well as between the DASH-score and pinch strength (r = -0.35). We suggest reporting the average Range of Motion (ROM) of the complete finger as a percentage of the contralateral finger, instead of reporting the classified result, and to include assessment of pinch strength. It would be very useful to have an accurate functional outcome assessment, but DASH proves to be insufficiently sensitive.

Adolescent↗
PubMed1997

A simulation of hand impairments: effects on upper extremity function and implications toward medical impairment rating and disability determination.

OBJECTIVES: To determine whether simulation of significant impairment of the hand will have a predictable impact on degree of functional loss at the wrist and hand. DESIGN: Single subject repeat measures using before-after trial comparisons and healthy volunteer subjects. SETTING: Occupational therapy section of a large academic medical center. OTHER PARTICIPANTS: Twenty adult volunteer student subjects from an occupational therapy education (OTE) department were included. All were between ages 18 and 43 years, right hand dominant, and in excellent general health. There were 19 women and 1 man, reflecting gender distribution of the OTE student body. INTERVENTION: A simulated fusion of the carpometacarpal (CMC) joint of the thumb was achieved by immobilization in an individually fabricated splint designed to maximally restrict motion at the first CMC joint. Impairment ratings (baseline vs splinted) according to the AMA Guides were obtained by Greenleaf testing, and upper extremity function was quantitatively assessed before and after splinting. MAIN OUTCOME MEASURES: Measures of upper extremity function included grip and pinch strength, wrist torque, and speed of performance on the Valpar Small Tools test, Jebsen Hand Function test, and an exploratory measure, the Functional Life Activity Test (FLAT). RESULTS: Significant impairments were achieved for all subjects after splinting and according to Greenleaf testing. Splinting resulted in significant reductions in grip and pinch strength, wrist torque, and significant slowing of performance on the Valpar, Jebsen, and FLAT tests. Regressions of degree of impairment on degree of functional loss after splinting, and according to each of the above measures, were not significant. CONCLUSIONS: Impairment of the hand was simulated to a mild-to-moderate degree as measured according to the AMA Guides. This imposed significant reductions in motion at key joints of the wrist and hand as well as significant reductions in grip and pinch strength and wrist torque. A corresponding and significant slowing of performance on a variety of measures of upper extremity function of an industrial and nonindustrial nature was also seen. However, and for the first time, correlation and regression reveals that it is not possible to predict degree of functional loss attributable to degree of impairment for the hand. It thus appears that, for mild-to-moderate clinical impairments, the associated impairment rating is a poor estimator of functional loss at the hand and should be used cautiously, if at all, as a criterion for disability determination.

Activities of Daily Living↗
PubMed1982

The hand and environment (3)--physiological changes of digital functions in two age groups studied by vibratory stimulations and a cold water immersion.

Skin temperature, vibratory sensibility and pinch strength of the hand were recorded continuously in 20 healthy adults through two vibratory stress tests (32 Hz and 125 Hz) and a cold water (10 degrees C) immersion (for 10 min) test in a climatic chamber (20 degrees C, 50% humidity). As a stressor to the hand, the immersion was the most effective and the vibrator stress at 32 Hz was next. As a detector for function of the hand, vibratory sensibility at 125 Hz was proved to be the most valuable and the digital temperature was the next. As to aging, the mature age group showed low vibratory sensibilities at 63 Hz, higher digital temperatures, stronger pinch strengths, and quicker recoveries after the stress tests. Along the passage of time after entering the chamber, the vibratory sensibilities and the pinch strengths did not show any changes. However, the digital temperatures became continuously lower.

Adult↗
PubMed2005

Functional outcome in patients with zone V flexor tendon injuries.

INTRODUCTION: Zone V flexor tendon injuries may involve major nerves and arteries as well as the wrist and finger flexors. Although these injuries are not infrequent, few studies have reported functional outcomes. The purpose of this study was to evaluate the functional outcome in patients with flexor tendon repairs in zone V. MATERIALS AND METHODS: Eighteen patients with repaired zone V flexor tendon injuries were followed up for an average of 20 months. The postoperative rehabilitation program consisted of a combined regime of modified Kleinert and modified Duran techniques. Outcome parameters were hand function according to the Buck-Gramcko assessment system, grip and key pinch strength values, and return to work status. RESULTS: Functional results were excellent in 92.8% of the digits, good in 1.4%, and poor in 5.8%. Grip strength recovered to an average of 77% and pinch strength to 74% of the uninjured hand. Two tendon ruptures occurred in a patient, and tenolysis was required in 3 patients. Of 15 patients who were employed at the time of injury, 13 returned to their original occupations. CONCLUSION: Satisfactory functional results can be obtained when proper surgical technique is coupled with careful postoperative management in patients with zone V flexor tendon injuries.

Adolescent↗
PubMed2001

Botulinum toxin type A in primary palmar hyperhidrosis: randomized, single-blind, two-dose study.

BACKGROUND: Primary palmar hyperhidrosis is characterized by excessive sweating due to increased sympathetic cholinergic sudomotor nerve traffic to the palmar surface of the hands. Clinical studies suggest that intradermal injections of botulinum toxin are effective in the treatment of palmar hyperhidrosis. OBJECTIVES: To establish the effectiveness of intradermal botulinum toxin in reducing hyperhidrosis, to determine the most effective dose of toxin, and to examine its effect on muscle strength. METHODS: In a prospective, single blind, randomized trial, 24 patients with severe palmar hyperhidrosis received either a low (50 U) or a high dose (100 U) of botulinum toxin type A (Botox, Allergan) injected intradermally in 20 sites in each palm. RESULTS: Following injection with either dose, iodine starch test revealed a significant decrease in sweating within the first month. Six months after injection, the anhidrotic effect was still evident in two thirds of the patients in both groups. Handgrip strength was not affected with either dose but finger pinch strength, 2 weeks after the injection, decreased 23 +/- 27% with 50 U (p < 0.05) and 40 +/- 21% with 100 U (p < 0.001). Pinch strength improved gradually but 6 months after treatment it was still 7-11% lower than at baseline. CONCLUSIONS: Both 50 and 100 U of botulinum toxin type A, injected intradermally in each hand, decreased sweating in patients with primary hyperhidrosis for at least 2 months in all the patients, and 6 months in most patients. Weakness in the intrinsic muscles of the hand was observed.

Adult↗
PubMed1986

Assessment of thumb to index pulp to pulp pinch grip strengths.

In this study of fifty men and women with normal hand function, the strength of thumb to index finger pulp to pulp pinch grip was assessed with the remaining fingers either flexed or extended. When the pinch grip was performed with the remaining fingers flexed the value was up to 92% higher than when the remaining fingers were extended. In future studies where thumb to index finger pinch grip is used as an objective test of function then the position of the remaining fingers must be defined to aid interpretation of the results.

Female↗
PubMedDate not supplied

Prospective analysis of splinting the first carpometacarpal joint: an objective, subjective, and radiographic assessment.

Predisposing factors contributing to the development of first carpometacarpal (CMC) osteoarthritis include an inherent laxity or incongruency of this joint, a shallow trapezium saddle, and heavy stresses placed on the joint with pinching and grasping. Splinting is a common mode of conservative treatment for CMC osteoarthritis. This study assessed the objective and subjective responses of patients with CMC osteoarthritis who wore short and long opponens splints, as well as radiographic changes associated with wearing of the splints. The study evaluated 26 hands. Each patient was assigned at random to wear the long or the short splint first. Patients wore the splints for one week. They then documented function in their splints (on 22 activities of daily living) and rated splint satisfaction and pain levels on visual analog scales. One week after application of the first splint, the second splint was applied and worn for one week, and all measures were repeated. On the final visit, tip pinches were evaluated and x-rays were taken to assess subluxation. One-way repeated-measure analysis and paired comparison were used to analyze the pinch, pain, radiographic, and splint-rating measures. Descriptive statistics were used to assess activity-of-daily-living function and splint preference. Both splints appear to reduce subluxation at the first CMC joint in patients with grades 1 and 2 osteoarthritis. The majority of the patients picked the short splint when asked at the end of the study which splint they preferred. The splints do not appear to increase pinch strength or affect pain levels associated with the performance of pinch strength measurements. This study supports anecdotal evidence that patients with CMC osteoarthritis get pain relief with splinting.

Activities of Daily Living↗
PubMed1992

Grip strength before and after carpal tunnel decompression.

We prospectively studied preoperative and postoperative grip and pinch strength in 21 patients having 30 consecutive median nerve decompressions for carpal tunnel syndrome. All procedures were done by one surgeon. Each hand operated on served as its own control and was studied by the same therapist preoperatively and at monthly intervals for 6 months after the procedure. An initial decline in both grip and pinch strength was noted in most hands during the first postoperative month. Eighty percent or more grip strength was regained in 65% of the hands at 2 months and in 81% at 3 or more months. In those hands (65%) that regained at least 100% of their preoperative grip strength at 3 or more months, there was an average increase in maximal grip of 56%, as compared with an average decrease of 20% in the remaining hands (35%).

Adult↗
PubMed2006

Dynamometry of intrinsic hand muscles in patients with Charcot-Marie-Tooth disease.

BACKGROUND: Several problems are associated with manual muscle testing and dynamometry in the hands of patients with Charcot-Marie-Tooth (CMT) disease. OBJECTIVE: To evaluate the efficacy of the Rotterdam Intrinsic Hand Myometer (RIHM) to directly measure intrinsic hand muscle strength in CMT disease. METHODS: We measured hand muscle strength and hand function in 41 patients with CMT disease. RESULTS: RIHM measurement of intrinsic strength had excellent reliability. We found overlapping RIHM strength values in Medical Research Council grades 3 to 5. High grip and pinch strength could be found in patients with severe intrinsic muscle weakness. RIHM measurements were more strongly correlated with fine motor skills of the hand than grip and pinch strength. CONCLUSIONS: The Rotterdam Intrinsic Hand Myometer is a reliable instrument to measure intrinsic hand muscles strength in patients with Charcot-Marie-Tooth disease, providing more detailed information than manual muscle testing and a more direct assessment of intrinsic muscle loss than grip and pinch dynamometers.

Adolescent↗
PubMed1995

Partial trapeziectomy and interpositional arthroplasty for trapeziometacarpal osteoarthritis of the thumb.

Partial excision including the articular surface of the trapezium and interpositional arthroplasty using one half of the flexor carpi radialis tendon was done in 36 hands. The joint capsule was reattached to the trapezium and the thumb immobilized for 4 weeks post-operatively. No ligament reconstruction was done. 30 hands (83.6%) had complete relief of pain. The average post-operative pinch strength was 11 lb. Three patients who complained of weakness of pinch had hyperextension of the MP joint. Correction of MP hyperextension is recommended to improve pinch strength. The outcome of this operation is comparable to any of the techniques described in the literature. The technique is simple and easy to perform. Since the capsule is closed the operation is truly an interpositional arthroplasty.

Aged↗
PubMed1997

A simple and inexpensive pinch meter to detect subclinical weakness among leprosy patients.

This paper describes the use of a neonatal sphygmomanometer cuff as a simple, inexpensive pinch meter. Normal values for key pinch, pulp pinch and side pinch in the dominant hand of healthy Nepali people are provided. The pinch meter was also used to test pinch strength in hands affected by leprosy and normal hands. Some patients with leprosy who have no objective weakness on voluntary muscle testing (VMT) have less pinch strength than people without leprosy. The pinch meter is a useful tool for the early detection of motor function loss.

Adolescent↗
PubMed1994

[The evaluation of the Artem grip in its function assessment].

The aim of our study is to assess the Artem pincers efficiency, which is both a new grip strength instrument and a hand reeducation instrument. It is original through its pleasant good looking and it offers many different programs of use. This study was carried out involving 60 healthy subjects. We compared the Artem system with two other measurement instruments of reference (Jamar for grip strength and Pinch-Gauge for pinch strength). With this Artem system we also studied two other originals tests: 1) Evolution of hand and finger strength within 15 seconds. 2) Tiredness test. Our measurements demonstrated good high correlation and high reliability between reference instruments and Artem system dealing with strength measurements. We can't conclude about the two original program's statistics, but it would probably be interesting to compare these with a group of patients in course of reeducation.

Adult↗
PubMed2003

Predictors for return to work in patients with median and ulnar nerve injuries.

PURPOSE: One of the consequences of median and ulnar nerve trauma is delayed return to work. The aim of this study was to determine return to work (RTW) and risk factors for delayed RTW in addition to time off work (TOW). Differences among median, ulnar, and combined median-ulnar nerve injuries were examined. METHOD: In this study 96 patients who were employed at the time of injury and who had undergone surgery for median, ulnar, or combined nerve injuries between 1990 and 1998 were evaluated. The response rate was 84% (n = 81). RESULTS: Within 1 year after injury, 59% (n = 48) returned to work. Mean TOW was 31.3 weeks. Return to work after combined nerve injuries was 24% versus after isolated median (80%) and ulnar (59%) nerve injuries. Level of education, type of job, and compliance to hand therapy were predictors for RTW. Furthermore, grip strength loss, tip pinch strength loss, and sensory recovery differed strongly between the RTW and no-RTW population. CONCLUSIONS: The predictors found in this study increase our understanding of delayed RTW after median and ulnar nerve injury and may be used to optimize postinjury rehabilitation.

Accidents, Occupational↗
PubMed2006

Interposition arthroplasty using trapezium tendon ball for osteoarthritis of the carpometacarpal joint of the thumb.

Carpometacarpal (CM) joint arthroplasty of the thumb using a trapezium tendon ball was performed in 11 hands of 9 patients with osteoarthritis. After a total dissection of the trapezium, the palmaris longus was wrapped around the trapezium, with the surfaces of both the CM joint and the scaphotrapezial joint tightly covered. Grafted trapezium was repositioned, and a congruency of the CM joint was confirmed. All patients were relieved from pain, with the radial abduction angle, grip strength, and the pinch strength increased 5 years after surgery. Radiographically, the mean width of the CM joint space increased, and a central migration of the first metacarpal bone was not found. This procedure would be available for the osteoarthritis in both the CM joint and the scaphotrapezial joint.

Arthroplasty↗