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Refereed/Peer-reviewed This study aimed to determine normative ranges of static pinch strength as measured with a spring gauge in adults of working age and investigate whether pinch strength is associated with hand hypermobility. A secondary aim was to explore whether the Beighton criteria for hypermobility are associated with hypermobility in joints of the hand during forceful pinching. Methods: A convenience sample of healthy men and women aged 18–65 years were recruited for measurement of lateral pinch, 2-point pinch, 3-point pinch, and joint hypermobility according to the Beighton criteria. Regression analysis was used to determine the effect of age, sex, and hypermobility on pinch strength. Results: Two hundred and fifty men and 270 women participated in this study. Men were stronger than women at all ages. Lateral and 3-point pinch were greatest for all participants and 2-point pinch was the least strong. There were no statistically significant differences between age groups, but a trend for the lowest pinch strength to occur before the mid-thirties was seen in both sexes. Thirty-eight percent of women and 19% of men were hypermobile; however, these participants statistically insignificant differ in pinch strength compared with other participants. The Beighton criteria corresponded strongly with hypermobility in other joints of the hand as observed and photographed during pinch. Hand dominance did not show clear relationships with pinch strength. Conclusions: Normative lateral, 2-point, and 3-point pinch strength data for adults of working age are presented with men having greatest pinch strength at all ages. The Beighton criteria for hypermobility are associated with hypermobility in other joints of the hand.

Background: Most studies on stroke have been designed to examine one deficit in isolation; yet, survivors often have multiple deficits in different domains. While the mechanisms underlying multiple-domain deficits remain poorly understood, network-theoretical methods may open new avenues of understanding. Methods: Fifty subacute stroke patients (7±3days poststroke) underwent diffusion-weighted magnetic resonance imaging and a battery of clinical tests of motor and cognitive functions. We defined indices of impairment in strength, dexterity, and attention. We also computed imaging-based probabilistic tractography and whole-brain connectomes. To efficiently integrate inputs from different sources, brain networks rely on a rich-club of a few hub nodes. Lesions harm efficiency, particularly when they target the rich-club. Overlaying individual lesion masks onto the tractograms enabled us to split the connectomes into their affected and unaffected parts and associate them to impairment. Results: We computed efficiency of the unaffected connectome and found it was more strongly correlated to impairment in strength, dexterity, and attention than efficiency of the total connectome. The magnitude of the correlation between efficiency and impairment followed the order attention>dexterity ≈ strength (strength: | r |=.03, P =0.02, dexterity: | r |=.30, P =0.05, attention: | r |=.55, P Conclusions: Attentional impairment is more sensitive to disruption of coordinated networks between brain regions than motor impairment, which is sensitive to disruption of localized networks. Providing more accurate reflections of actually functioning parts of the network enables the incorporation of information about the impact of brain lesions on connectomics contributing to a better understanding of underlying stroke mechanisms.

Study Design Clinical Measurement Introduction Jar opening is a task that relies heavily on the ability to generate adequate hand forces and is often reported in the literature as being difficult for women with hand arthritis. Many have studied relationships between diminished grip/pinch strength and occupational performance but few have investigated how much hand force is necessary to successfully engage in manual tasks. Those who studied this have relied on approaches and tools which lack ecology. Additionally, few have instrumented daily objects to understand if joint protection techniques do, in fact, reduce the hand force generation when performing manual tasks. Purpose of the Study The objectives of this study were to one) determine the within session repeatability of a device used to quantify these forces and two) probe into the ecological validity of a novel device to be used in the future study of women with hand osteoarthritis to measure hand force requirements and study the impact of joint protection interventions on hand force profiles. Methods A plastic jar was instrumented with a torque limiter, 6-axis load cell, and six force sensing resistors so as to capture the grip and compressive hand forces which act on a jar lid when opening a sealed jar. To assess intra-rater reliability of the tool and its testing procedures, 31 adult women with hand osteoarthritis were asked untwist the jar's lid so as to break its seal with each hand twice while stabilizing the base with the opposing hand. The agreement between trials of peak forces and torques from each hand was assessed through statistical approaches including Intraclass Correlation Coefficient, Standard Error of the Measurement, and Minimal Detectable Change. The jar's ecological validity was then assessed via survey. Results This instrument and methods yielded good to excellent repeatability across all force outputs. The majority of our subjects (87%) reported the jar to be similar to those used at home, 87% reported to use a similar jar 2-3 times/month or greater, and rated the importance of opening such a jar as being, on average, 8.7/10. Discussion The jar instrument appears to have high reliability and ecologic validity. It has the potential to reveal hand force requirements for a population known to have difficulties opening jars and understanding these force thresholds could help to inform therapy goal-setting. Beyond this, it has the potential to support the study of the hand forces used across various joint protection approaches so as to inform best “jar-opening” practices. Conclusions This tool was designed to represent the qualities of a standard, large sealed jar while still housing sophisticated kinetic measurement capacities. Our findings support that we have presented a tool which can be used in future study within this population to better understand the hand kinetics associated with the highly problematic task of jar-opening and joint protection strategies intended to reduce hand loads.

The index finger plays a major role in hand function. Subjects who sustain traumatic amputation of the single index finger also suffer both psychological and functional loss. Most of previous studies primarily focused on psychological benefits with finger prosthesis; however, it is essential to identify the functional benefit of the silicone finger in respective activity spectrum. To determine the improvement in function and activities with silicone finger prosthesis in proximal phalanx index finger amputation. Sixteen subjects were evaluated for the grip strength, pinch strength, and activities with dynamometer position II, pinchometer, and DASH questionnaire, respectively. Significant improvement of grip strength revealed in dynamometer position II ( p = 0.041) when tested without and with silicone finger prosthesis. The overall abilities in activities of daily living were improved significantly ( p = 0.005) as assessed by disability of arm, shoulder and hand questionnaire. Large effect sizes were noted in some activities like writing, jar opening, and carrying heavy object. Silicone finger prosthesis provides a functional benefit to the subjects in multiple activities. Partial loss of a finger has a relationship in limitation of hand function. Generally, clinicians prescribe silicone prosthesis for rehabilitation of finger amputee to restore the cosmetic purpose; however, functionality of the finger is also required to be restored. This study describes the role of silicone finger prosthesis on function and different activities for the subjects suffering from the index finger proximal phalanx amputation. Nayak S, Lenka PK, Equebal A, et al. Impact of Silicone Finger Prosthesis in Activities of Daily Living and Passive Function in Proximal Phalanx Index Finger Amputation. Indian J Phys Med Rehab 2019;30(3):59–65.

Background: There is poor understanding regarding functional limitation of thumb strength and dexterity following thumb metacarpophalangeal (MCP) and interphalangeal (IP) arthrodesis. The purpose of this investigation was to quantitatively evaluate the functional limitations of MCP and IP joint fusion using an orthosis to simulate fusion. Methods: Thirty-two healthy volunteers underwent simulated MCP and IP thumb arthrodesis using custom-molded orthoses. Each volunteer was independently assessed for hand and thumb function using the Jebsen-Taylor Hand Function test, lateral pinch strength, tip pinch strength, and Grooved Pegboard test. Comparisons between the 3 groups in all functional tests were carried out. Results: The mean lateral pinch strength was significantly greater in the unsplinted group (8.3 kg) compared with the MCP- (6.3 kg) and IP-splinted (5.7 kg) groups. Mean tip pinch strength was also significantly higher in the unsplinted group than in MCP- and IP-splinted thumbs (4.6 kg vs 4.1 and 3.9 kg). There was no difference in the Jebsen-Taylor or Grooved Pegboard test between the 3 groups. Conclusion: Our study suggests that with a fused MCP joint the lateral and tip pinch strength will decrease by 24% and 10%, respectively, compared with a healthy nonsplinted thumb. A fused IP joint will decrease lateral and tip pinch by 31% and 16%, respectively. This information does not take into account an arthritic thumb. We found that the Jebsen-Taylor test and Grooved Pegboard test were not affected by simulated thumb MCP and IP fusion.

Purpose Patients undergoing surgery for trapeziometacarpal (TMC) joint arthritis require preoperative counseling on the expectations of surgery. This study aims to document the objective and functional recovery over the initial 12 months following trapeziectomy and ligament reconstruction with tendon interposition (LRTI). Methods We prospectively followed 55 patients with symptomatic TMC joint osteoarthritis after trapeziectomy and LRTI. Patients were assessed on functional outcome measures, pain, and objective outcomes of grip, tip and key pinch strength, and range of motion. Outcomes were recorded preoperatively and at 3, 6, 9, and 12 months after surgery. Results Outcome measures of Disabilities of the Arm, Shoulder, and Hand (DASH), Patient-Rated Wrist Evaluation (PRWE), and pain, improved significantly after surgery at each 3-month interval up to 9 months. Palmar and radial abduction were significantly improved compared to their preoperative ranges, but opposition was unchanged. Power grip significantly exceeded the preoperative strength at 6 months and further increased at 9 months. Tip pinch significantly exceeded the preoperative strength at 12 months. There was no difference in the key pinch strength compared to the preoperative strength. Conclusions Over a follow-up period of 12 months, trapeziectomy and LRTI is an effective treatment in significantly reducing pain in 80% of patients. Although normal patient-reported outcome measures of DASH and PRWE are not regained, when compared to normative values, these measures are significantly improved; the improvement plateaus at 9 months. Patients can expect to attain 37% and 46% of their eventual measured DASH and PRWE scores, respectively, at 3 months, and 82% and 79% of their eventual measured DASH and PRWE scores, respectively, at 6 months. Grip strength exceeded the preoperative strength by 15% at 6 months and by 30% at 9 months. Tip pinch strength significantly exceeded the preoperative strength by 20% at 9 months. Type of study/level of evidence Therapeutic II.

Study Design: Retrospective case series.Purpose: This study aimed to examine the efficacy of composite grip strength as a marker of surgical outcome in patients with moderate to severe degenerative cervical myelopathy.Overview of Literature: Degenerative cervical myelopathy causes loss of dexterity, muscle strength, and sensations in the hand. The impact of surgical management on improvement in composite grip strength has received scant attention.Methods: This retrospective study was performed on degenerative cervical myelopathy patients with a complete composite grip strength assessment between January 2013 to January 2019. The Biometrics E-link hand kit was used for the assessment. The following parameters were measured: maximum grip strength, sustained grip strength, three-jaw pinch, maximum key pinch, and sustained key pinch. The pre- and postoperative functional status was assessed using the Nurick grade and the modified Japanese Orthopaedic Association (mJOA) score.Results: A total of 40 patients were included in the study. The mean patient age was 51.9 years. The mean preoperative Nurick grade was 3.5 and the mJOA score was 10.9. The anterior approach was used in 25 patients, and the posterior approach was used in 15 patients. Four patients developed complications. Degenerative cervical myelopathy resulted in decreased handgrip and pinch strength as compared to normative Indian data. There was a significant improvement in the postoperative composite grip strength for all five parameters. There was no differential improvement between the anterior and posterior surgical groups. The improvement in the composite grip strength correlated with the improvement in functional scores.Conclusions: Composite grip strength analysis is an objective method for assessing the impact of degenerative cervical myelopathy on grip strength and monitoring the postoperative improvement. Decompressive surgery resulted in global improvement in all the parameters of composite grip strength.

Trapeziectomy is performed for trapeziometacarpal (TMC) arthritis but decreased lateral pinch strength is a major source of discomfort after the surgery. The magnitude of the decrease is unclear, however, and how the pressure changes in the TMC joint is unknown. To investigate this relationship, we designed a cadaveric study to measure TMC joint pressure using a lateral pinch model, and quantitatively evaluated the effect of trapeziectomy on the pressure measurements. For 10 cadaveric forearms, physiologic forces were applied across the thumb TMC joint by loading five tendons, thereby simulating lateral pinch. Using pressure sensors, we measured the lateral pinch pressure and TMC joint pressure, which averaged 10.1 (range, 4.2-16.2) kg/cm2 and 2.0 (range, 0.8-4.4) kg/cm2 , respectively. A significant correlation between the measurements was found, with an average ratio of 19% (range, 10%-27%). After trapeziectomy and interposition of the tendon ball using flexor carpi radialis, the pressure measurements were repeated under the same conditions. Significant changes were found, which averaged 5.1 (range, 1.7-10.7) kg/cm2 for lateral pinch pressure and 15.0 (range, 5.6-25.6) kg/cm2 for TMC joint pressure. In conclusion, TMC joint pressure could be measured as the ratio relative to lateral pinch pressure using a cadaveric model. After trapeziectomy, the lateral pinch strength decreased, whereas the TMC joint pressure increased.

This study aimed to compare the results of patients treated with a thumb carpometacarpal (CMC) suspension arthroplasty using an interference screw technique with patients that were treated by trapeziectomy and ligament reconstruction. A retrospective chart review was conducted of patients over 18 years old who required surgical treatment for thumb CMC joint arthritis treated by a single surgeon. Patients included in the study followed the same preoperative and postoperative protocol. Information related to functional outcomes was collected (pinch and grip strength, pain, Kapandji score, proximal migration of first metacarpal bone). One hundred and five patients were included, 77% were female, age at the time of the study was 62.7 years old; 74 (70%) patients were treated with the tenodesis screw (TS) technique and 31 (30%) with trapeziectomy and ligament reconstruction (TZLR). Patients were followed for a mean of 8.4 months. Postoperative pain was 1.2 in the TS group and 0.6 in the TZLR group; Kapandji score was 8.3 in the TS group and 9 in the TZLR group; in the TS group, the grip strength was 26.2kg and key pinch strength was 6.15kg; in the TZLR group, grip strength was 12.8kg and key pinch strength was 4.7kg. Proximal migration was 0.4cm in the TZLR group and 0.6cm in the TS group. The use of tenodesis screw and half of the flexor carpi radialis had minor advantages, such as increasing the grip and key pinch strength without differences relative the non-operated thumb, minimal migration of the first metacarpal bone compared with the other technique.

Our aim was to explore the different indications of the Mini TightRope® suture button whether during first-line treatment or secondary surgery of thumb carpometacarpal osteoarthritis (OA). The indications for this new device are presented and discussed based on our own small case series and published data. Twenty-one patients treated with the Mini TightRope® were included in a prospective study. One of them was operated on both sides. Fourteen devices were used in first intention for Eaton stage IV OA; the patients underwent trapeziectomy and suture button suspensioplasty only. Four cases consisted of revision surgery for painful proximalization of the first metacarpal after trapeziectomy and ligamentoplasty. Four cases consisted of secondary surgery after trapeziectomy and implant interposition (two silicone implants and two pyrocarbon implants). We captured the demographic data, follow-up time, pain level, pinch strength before and after surgery, range of motion, metacarpal subsidence, and postoperative complications. The average age of the patients was 60 years. There were 19 women and 2 men. The average follow-up time was 2.5 years (1–4). The average pain level, according to a visual analog scale (1–10) was 3.5 (2–5) preoperatively and 2 (1–4) postoperatively at rest and 7 (6–8) preoperatively and 4 (3–6) postoperatively with maximum load. The mean Kapandji score was 9 (7–10) and the retropulsion score was 3 (1–4). The average key pinch and tip pinch strengths were 80% and 78% of the contralateral side at the final follow-up. The trapeziectomy-suspensioplasty group had greater average trapezial space height compared to the revision surgery group (7.0 mm vs. 4.5 mm). There are several indications for the Mini TightRope® device in the treatment of severe thumb carpometacarpal OA: first metacarpal suspension during open or arthroscopic total or partial trapeziectomy and secondary surgery after failure of trapeziectomy with or without implant interposition. The advantage of this new device, which suspends the first metacarpal off the second metacarpal, is the very short immobilization period contrary to other suspensioplasty procedures.

Aim: The purpose of this study was to develop an instrument-Smart Virtual Physical Therapist (SVPT) that assess the pinch grip strength and its measurement was recorded on a Smartphone application, and to validate Smart Virtual Physical Therapist device with standard pinchometer device. Method: Observational study was carried out on 40 patients having neurological condition and grip affection of 20-70 years of age. Measurement of pinch grip strength was done with SVPT device and pinchometer between pulp of thumb and pulp of index finger, middle finger, ring finger and little finger. The measurement was recorded in kilogram. Measurements were done once with right hand and then with left hand. Results: Mean values for pinch grip by SVPT device for index, middle, ring and little finger of right hand were 1.92kg, 1.74kg, 1.40kg, 1.11kg and left hand were 1.84kg, 1.71kg, 1.43kg, 1.04kg respectively. In addition to it mean values by pinchometer for index, middle, ring and little finger of right hand were 3.02kg, 2.87kg, 2.17kg, 1.61kg and left hand were 2.84kg, 2.94kg, 2.28kg, 1.62kg respectively. K value for index, middle, ring and little finger of right and left hand was 0.2. There were 25% of people who were unable to do pinch grip using pinchometer. Conclusion: Smart Virtual Physical Therapist device can’t be replaceable with the standard baseline pinchometer to assess the grip strength. But it is a valid tool to measure pinch grip strength in neurological patients due to greater height of pressure sensor of SVPT device for pad to pad grip. Key words: Hand, Instrumentation, Pinch strength.

Background and Aim The adverse effects of smartphone size and weight on the hand and hand function have not been studied extensively. This study aimed to investigate the changes to the flexor pollicis longus tendon and median nerve using diagnostic ultrasound for high and low addiction smartphone users. Methodology In this cross-sectional study, 54 healthy male university students were divided into two groups according to the Smartphone Addiction Scale: high and low users. Demographic data, hand grip strength (kg), pinch strength (kg), and smartphone weight, length and width were measured and recorded. Diagnostic ultrasound examination determined the cross-sectional area of the median nerve (mm2) and flexor pollicis longus tendon (mm2) of the dominant and non-dominant hand. Result The cross-sectional area of the median nerve was significantly higher in the high-user group (7.4±1.3 mm2) than the low-user group (6.7±1.0 mm2). The correlation of phone weight, length and width with median nerve area was respectively positive, higher and significant (0.718, 0.747, and 0.733; p Conclusion The findings of the current study demonstrates that change to the median nerve and flexor pollicis longus tendon, could be linked to the width, weight and length of the smartphone and high addiction.

Objective. Diabetic peripheral neuropathy (DPN) is one of the most common chronic complications of diabetes, leading to disability and decreased quality of life. In past research and clinical studies, the lower limb function of DPN patients was often the principal subject of research, with little attention given to the upper limb and hand. Our goal was to assess and compare hand function between elderly diabetic patients with DPN and without DPN. Methods. A total of 52 diabetic patients were registered and underwent hand function assessments and electrodiagnostic tests. Dynamometer, pinch meter, Semmes Weinstein monofilaments, and the Purdue Pegboard Test (PPT) were used to assess the patients’ grip strength, pinch strength, tactile sensory threshold, and hand dexterity. Results. Compared with the non-DPN group, the elderly DPN group showed worse thumb-middle fingertip pinch strength and thumb-little fingertip pinch strength in the dominant hand (3.50 (2.50, 4.25) vs. 4.50 (3.00, 5.00), p = 0.019 ; 1.50 (1.00, 2.00) vs. 2.50 (2.00, 3.00), p < 0.001 ); the elderly DPN group displayed worse thumb-middle fingertip pinch strength, thumb-ring fingertip pinch strength, and thumb-little fingertip pinch strength in the nondominant hand (3.50 (2.00, 4.50) vs. 4.00 (3.00, 5.00), p = 0.013 ; 2.50 (1.25, 3.00) vs. 3.00 (2.50, 3.50), p = 0.033 ; 1.00 (0.75, 2.25) vs. 2.50 (2.00, 2.50), p < 0.001 ). The elderly DPN group scored lower than the non-DPN group on the PPT test of assembly ( 13.96 ± 5.18 vs. 16.96 ± 4.61 , t = 2.212 , p = 0.032 ). Conclusion. Motor function limitation is the principal hand dysfunction in elderly patients with DPN, which is mainly manifested as a decline in fingertip pinch strength and a decrease in hand dexterity. This trial is registered with Clinical Trial Registry no. ChiCTR1900025358.

In lateral material handling tasks, which is very common in industries, warehouse systems, and other sectors, the workers can lead to work-related musculoskeletal disorders (WMSDs) because of the task and work designs, especially in upper extremities. WMSDs in hand, wrist, and fingers cause workers to have health problems, in pain and uncomfortable, hence decrease their working productivity and efficiency. The workstations distances are one of the factors that might affect workers when they perform manual material handling laterally, which can lead to WMSDs in hands. Hence, there is a need to study the relationship between transfer distances with the hand grip and pinch strengths. An experiment was carried out with 30 male participants to identify the relationship of lateral transfer distances with the hand grip and pinch strengths. The results obtained from the experiment were further investigated and analysed by using repeated measure one-way MANOVA and graphs. The results had proved that in the distances of 1.0 m, 1.25 m and 1.5 m did not affect one’s hand grip and pinch strengths. But, the postures and movements were varied based on distances. ABSTRAK: Pengangkutan barang atau bahan secara lateral amat biasa dalam industri, gudang dan sektor-sektor lain, dan kerja ini akan menyebabkan pekerja menghadapi penyakit gangguan muskuloskeletal berkaitan kerja (WMSDs) terutamanya di bahagian tangan. WMSDs yang melibatkan tangan dan jari menyebabkan pekerja mempunyai masalah kesihatan secara kekal dan mengalami kesakitan serta tidak-keselesaan. Secara tidak langsung, masalah ini telah mengurangkan prestasi mereka ketika bekerja. Syarikat terpaksa memberi bayaran yang tinggi kepada pekerja untuk kos perubatan and mengalami kerugian besar kerana pekerja yang tidak datang bekerja disebabkan penyakit tersebut. Jarak antara dua stesen kerja adalah faktor yang menyebabkan penyakit ini dihadapi oleh pekerja. Oleh itu, kajian diperlukan untuk mengkaji hubungan antara jarak dan kekuatan genggaman tangan serta jari. Satu esperimen yang melibatkan 30 orang lelaki responden telah dijalankan untuk mengenal pasti hubungan antara jarak dan ganggaman tangan serta jari. Hasil daripada esperimen telah dikaji dan dianalisiskan dengan menggunakan MANOVA dan grafs. Hasil kajian telah membuktikan bahawa jarak dalam 1.0m, 1.25m dan 1.5m tidak membawa apa-apa kesan terhadap genggaman tangan dan jari. Cara dan pergerakan responden adalah berbeza dan disebabkan oleh jarak, walaubagaimanapun, cara dan pergerakan responden tidak membawa sebarang kesan terhadap kekuatan genggaman tangan dan jari mereka.

Introduction The Baseline® 5 position hydraulic pinch meter allows pinch strength assessment at five different pinch spans. The present study used this newly developed meter to assess where pinch span force is the greatest as previous literature is conflicting. Purpose of the Study The primary aim of the study was development of normative data using health subjects, whereas the secondary aims were to evaluate meter inter-rater reliability and to identify in which pinch span the greatest force was produced. Study Design This is a clinical measurement, cross-sectional study. Methods Ten occupational therapy student raters examined inter-rater reliability by calculating an average intraclass correlation. Recruitment of normative data subjects occurred across various locations in West Michigan to include a diverse population and followed testing procedures recommended by the American Society of Hand Therapists. Data were stratified by age categories and sex to develop normative standards. Data were analyzed using a one-way repeated measures ANOVA and a three-way mixed ANOVA. Results Normative data were calculated from a sample of 605 subjects (292 males and 313 females). One-way ANOVA demonstrated a significant difference at the five different spans, noting a small effect size. Also noted were a nonsignificant three-way interaction between age category, pinch spans, and sex using both the right and left hands, along with a significant two-way interaction between spans and sex bilaterally. Discussion The meter showed an excellent inter-rater reliability with an intraclass correlation = .98 and indicated the pinch span that produced the greatest amount of force was not consistent with previous literature.

Background: The effectiveness of Manual Therapy (MT) in thumb carpometacarpal osteoarthritis (OA) is unclear.Objective: This study aimed to determine the effectiveness of MT for functional outcomes in patients with thumb carpometacarpal OA. Design: Systematic review and meta-analysis of randomized clinical trials. Methods: An electronic search was performed in the Medline, Central, Embase, PEDro, Lilacs, Cinahl, SPORTDiscus, and Web of Science databases. The eligibility criteria for selecting studies included randomized clinical trials that compared MT versus other interventions in functional outcomes, such as thumb and/or hand function questionnaires, pinch and/or grip strength, thumb and/or hand range of motion, and pain intensity or pressure pain threshold in patients with thumb carpometacarpal OA. Results: Five clinical trials met the eligibility criteria; for the quantitative synthesis, four studies were included. The mean difference (MD) for grip strength was 0.87kg (95% CI = 0.29-1.44, p = .003), for pinch strength was 0.10kg (95% CI = -0.01-0.20, p = .06), and for the pressure pain threshold was 0.64kg/cm2 (95% CI = 0.07-1.20, p = .03). All differences were in favor of the MT group. Conclusions: In the short-term, there was moderate to high evidence, with statistically significant differences in the functional outcomes, in favor of MT versus sham interventions in patients with thumb carpometacarpal OA. However, these differences are not clinically important.

To assess the efficacy of a motion-sensing, hands-free gaming device and task-oriented training (TOT) programs on improving hand function, activity performance, and satisfaction in pediatric hand burns.A randomized controlled trial.Outpatient rehabilitation center.Fifty children with deep partial-thickness or full-thickness hand burns. (N=50; mean age, 10.70±1.64y; range, 7-14y) INTERVENTIONS: Children were randomized into 1 of the following 3 groups: the motion-sensing, hands-free gaming device group that used interactive video games plus traditional rehabilitation (TR); the TOT group that used real materials plus TR; and the control group that only received TR, all groups received the interventions 3 days per week for 8 weeks.We assessed the children at the baseline and after 8 weeks of intervention. The primary outcome measures were the Jebsen-Taylor Hand Function Test, Duruoz Hand Index (DHI), and Canadian Occupational Performance Measure (COPM). The secondary outcome measures were range of motion (ROM) of the digits, grip strength, and pinch strengths (tip, palmer, and lateral pinch).There was a significant increase in all measurements of the motion-sensing, hands-free gaming device and TOT groups compared with that of the control group postintervention (P.05). There was no significant change in Jebsen-Taylor Hand Function Test, COPM performance, ROM, grip strength, and tip and lateral pinch strengths between the motion-sensing, hands-free gaming device group and TOT group (P.05), whereas there was a significant increase in DHI, COPM satisfaction, and palmer pinch strength (P.05) in the motion-sensing, hands-free gaming device group compared with the TOT group postintervention.The motion-sensing, hands-free gaming device and TOT programs resulted in significant improvement in hand function, activity performance and satisfaction, ROM of the digits, grip strength, and pinch strengths in pediatric hand burns compared with the traditional hand rehabilitation.

ObjectiveThe purpose of this study was to investigate the test–retest reliability, measurement error, and interpretability of new motor fatigability outcomes of grip and pinch strength for children with unilateral cerebral palsy (UCP).MethodsMotor fatigability during grip and pinch strength was measured twice (within 48 hours) in both hands of 50 children (mean age = 11 years 2 months; 14, 31, and 5 children with Manual Ability Classification System levels I, II, and III, respectively) using a 30-second static and dynamic maximum exertion protocol. For static motor fatigability, the Static Fatigue Index (SFI) and mean force (Fmean) in the first (Fmean1) and last (Fmean3) 10 seconds were calculated. For dynamic motor fatigability, Fmean1, Fmean3, and the number of peaks in the first and last 10 seconds were calculated.ResultsFor static motor fatigability, the intraclass correlation coefficients (ICCs) were moderate to high for Fmean1 and Fmean3 (0.56–0.88), and the SFI showed low to moderate reliability (ICC = 0.32–0.72). For dynamic motor fatigability, the ICCs were moderate to high for all outcomes (0.54–0.91). The standard error of measurement agreement and the smallest detectable difference agreement were large in all outcomes, except for the SFI in static motor fatigability. Details per age group are provided. In general, younger children (6–11 years old) showed lower reliability than older children (12–18 years old).ConclusionMost outcome measures for static and dynamic motor fatigability of grip and pinch strength show moderate to high reliability in children with UCP, indicating that these tests can be used reliably to investigate the presence of motor fatigability in UCP, especially in older children. Standard error of measurement agreement and smallest detectable difference agreement indicated that these outcome measures should be interpreted with caution when evaluating change.ImpactMost of the proposed outcome measures for static and dynamic motor fatigability of grip and pinch are reliable in children with UCP and can be used for discriminative purposes.

Background: Dentists are required to maintain a high level of precision during manual scaling, polishing and Flossing. As a result of sustained griping activity finger and wrist pain are more common among Dentists. Therefore the excess pinch force, leads to musculoskeletal disorders which in turn affects the functional ability. Study design: An Experimental study. Materials & Methods: The sum of 30 Dental professionals were selected under inclusion criteria into this study, ages between 20 to 35 years with decrease in pinch strength and functional abilities. Selected subjects were randomly allocated into two groups such as experimental group (Pinch strength training and conventional exercise) and control group (Conventional Exercises - Postural corrective exercises, active range of motion exercises, shoulder bracing and shoulder shrugging exercise, Ergonomics advices) were given. The outcome tools used are Modified Sphygmomanometer test and Disabilities of the Arm, Shoulder and Hand Questionnaires (DASH). The Statistical analysis of pre &post test values were analyzed using paired & unpaired ‘t’ test. Result: The result of this study shows that Group A using Pinch strength along with Postural Education were found to be effective over the control group, where only the postural education were done (p

Background Patients with ulnar nerve paralysis note difficulties performing activities of daily living because of weakness of pinch and altered grasp mechanism. This review investigates outcomes of tendon transfers for ulnar nerve paralysis to assist in shared decision-making with patients during preoperative counseling and to inform operative choices. Methods A systematic review was conducted to identify studies reporting outcomes following tendon transfer for ulnar nerve palsy. Studies were screened according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and inclusion and exclusion criteria were applied. Primary outcome measures included postoperative pinch strength and mechanism of grasp. Results A total of 26 studies (687 patients) met criteria for inclusion. After pooled analysis, the flexor digitorum superficialis lasso procedure yielded the highest rate of complete correction of claw deformity (60.6 percent), followed by flexor digitorum superficialis four-tail operation (31.4 percent). The extensor carpi radialis longus four-tail operation yielded the greatest improvement in grip strength (3.8 kg). The extensor carpi radialis brevis four-tail operation resulted in the best open hand assessment and mechanism of closing scores; however, these studies did not objectively evaluate grip strength. The greatest increase in pinch strength was following tendon transfer to adductor pollicis alone. Conclusions Despite the heterogeneous data, if the primary goal is improvement in the appearance of claw deformity, the evidence supports flexor digitorum superficialis lasso transfer. However, if the primary concern is grip strength, the data favor extensor carpi radialis longus four-tail transfer. When pinch strength is functionally limiting, adductorplasty alone is most effective. These data will assist providers in appropriately informing patients of common risks and complications and setting realistic expectations following tendon transfer procedures.

Objective To investigate the effects of perturbation-based pinch task training on the sensorimotor performance of the upper extremities of patients with chronic stroke via a novel vibrotactile therapy system. Design A single-blinded randomized controlled trial. Setting A university hospital. Participants Patients with chronic stroke (N=19) randomly assigned into either an experimental group or a control group completed the study. Interventions In addition to 10 minutes of traditional sensorimotor facilitation, each participant in the experimental group received 20 minutes of perturbation-based pinch task training in each treatment session, and the controls received 20 minutes of task-specific motor training twice a week for 6 weeks. Main Outcome Measures The scores for the primary outcome, Semmes-Weinstein monofilament (SWM), and those for the secondary outcomes, Fugl-Meyer Assessment (FMA), amount of use, quality of movement (QOM) on the Motor Activity Log (MAL) scale, and box and block test (BBT), were recorded. All outcome measures were recorded at pretreatment, post treatment, and 12-week follow-up. Results There were statistically significant between-group differences in the training-induced improvements revealed in the SWM results (P=.04) immediately after training and in the BBT results (P=.05) at the 12-week follow-up. The changes in muscle tone and in the QOM, SWM, and BBT scores indicated statistically significant improvements after 12 sessions of treatment for the experimental group. For the control group, a significant statistical improvement was found in the wrist (P Conclusions This study indicated that the perturbation-based pinch task training has beneficial effects on sensory restoration of the affected thumb in patients with chronic stroke.

Objectives: To reach agreement on standardized protocols for assessing upper limb strength and grip and pinch force for upper limb reconstructive surgery for tetraplegia. Methods: Selected members of an expert panel composed of international therapists formed at the 2018 International Congress for Upper Limb Surgery for Tetraplegia conducted a literature review of current practice that identified gaps and inconsistencies in measurement protocols and presented to workshop attendees. To resolve discrepancies, a set of questions was presented to workshop attendees who voted electronically. Consensus was set at 75% agreement. Results: For manual muscle testing, consensus was reached for using the Medical Research Council scale, without plus or minus, and the use of resistance through range when testing grade 4 and grade 5 strength. Pectoralis major and serratus anterior should be routinely tested, however there was no consensus on other shoulder muscles. Grip and pinch strength should be tested according to the American Society of Hand Therapists positioning. For grip strength, either the Jamar or Biometrics dynamometer expressed in kilograms should be used. For grip and pinch strength, three measurements should be performed at each testing. No consensus was reached on a device for pinch strength. Conclusion: This work is an important step to enable comparable data in the future. Further consensus methods will work toward developing more comprehensive guidelines in this population. Building international consensus for pre- and postoperative measures of function supports objective evaluation of novel therapies and interpretation of multicenter studies.

Data on the efficacy of treatment modalities in De Quervain's tenosynovitis (DQT) is limited. Paraffin therapy is routinely used in treating hand osteoarthritis and neuropathies. However, there are not enough studies investigating paraffin effectiveness. This study evaluates the effectiveness of paraffin bath therapy on pain, functional status, muscle strength, and quality of life in patients with DQT. This prospective, single-blind, randomized, controlled study enrolled 51 DQT patients. Group 1 (n = 26) received paraffin bath + splint + exercise; Group 2 (n = 25) received splint + exercise therapy. Pain, handgrip strength, thumb palmar pinch strength, functional status, and quality of life were evaluated. Both treatment combinations improved pain, grip strength, palmar pinch strength of the thumb, functional status, and quality of life. The paraffin group provided more effective pain control than the paraffin-free group and was more effective in improving functional status, handgrip strength, and quality of life (p < 0.05). Apparently, adding paraffin therapy to the combination of the splint and therapeutic exercise positively affects the patient's treatment outcomes. For this reason, paraffin therapy should be included in the conservative treatment combinations in DQT.

Correction of unequal radial polydactyly in which neither thumb duplicates possess both well-developed proximal and distal components, remains challenging. Current techniques using on-top plasty techniques require circumferential incisions, often resulting in postoperative swelling and dorsal scars. We described our experience using a volar approach to achieve better aesthetic and functional results. Twenty-one patients underwent this surgery between 2008 and 2018, with a mean follow-up of 5.1 years. The mean flexion–extension arc for the metacarpophalangeal joint was 75° and that of the interphalangeal joint was 43°. Mean percentage of key, tripod and tip pinch strength were 77%, 79% and 77%, respectively, when compared with the contralateral side. The Vancouver Scar Scale showed an average score of 1.2. We conclude from our study that the volar approach to on-top plasty is a good technique for the correction of unequal radial polydactyly, with good functional and aesthetic results. Level of evidence: IV

Introduction and aim: Wrist injuries by colles’ or fracture of distal radius are the most prominent diagnosis referred to occupational therapy department for work program in India. In this project, a modified therapeutic work program for wrist injuries was evaluated. The objective of the study is to find out whether MTWP addressed to enhance the grip strength so as work skills and its success in the client return to work, level of work satisfaction & self-performance level post injured wrist. Methods: Single group pretest posttest experimental design followed by descriptive analysis.51 patients with dominant hand injured, shared similar demographic background with post-injured from 8 to 40 weeks with mean age of 16 weeks. Results: 94% clients who completed the program returned to work and switched over to different position and different type of work. 56% clients return to competitive employment with same work type, work situation, having work satisfaction and 80-100% work skills in compare to pre MTWP work situation. Discussion: The MTWP addresses the range of needs demonstrated by wrist injuries clients, from traditional therapy to prevocational and vocational intervention. The evaluation of the program indicates that the program was successful with wrist injury working age adult. PROGRAM DESCRIPTION (MTWP) The program is designed to help an individual to make a gradual, progressive transition from a medical setting to work placement and community reentry. MTWP has 6 phases. The client functional status and progress were monitored on an ongoing basis, and transition to new phases was determined by the Occupational Therapist and based on the client needs. Not all clients went through each phase or follow the sequence. Client continues with individual occupational therapy throughout their involvement in the MTWP. KEY WORDS: MTWP, colles fracture, vocation, wrist injuries, grip strength, pinch strength.

Chronic kidney disease (CKD) patients are at increased risk of sarcopenic muscle wasting, with increased mortality risk. Simple screening tests are required to detect sarcopenia to allow for interventional therapies. We wished to compare anthropometric and multifrequency bioimpedance (MFBIA) measurements of arm composition and muscle strength.We measured segmental MFBIA, mid arm upper circumference (MUAC) and triceps skin fold thickness (TSF), hand grip strength (HGS) and pinch strength (PS) in CKD patients attending out-patient review.We reviewed 146 patients; 94 male (64.4%), 93 (63.7%) diabetic, mean age 70.5 ± 15 years, weight 77.6 ± 17.1 kg, with a mean HGS of 25.2 ± 10.4, and PS 5.0 ± 1.9 kg. HGS and PS were correlated (r = 0.63, p 0.001). Male patients had greater HGS and PS (28.3 ± 10.1 vs 19.7 ± 7.0 kg; and 5.3 ± 2.0 vs 4.3 ± 1.1 kg, p 0.05) with greater arm muscle (3.2 ± 0.7 vs 2.4 ± 0.7 kg, p 0.05) and less arm fat (1.8 ± 1.3 vs 2.9 ± 1.8 kg, p 0.05), whereas there was no difference in anthropometric measurements of mid upper arm muscle or fat area. Whereas both HGS and PS correlated positively with MFBIA arm lean mass (r = 0.55, r = 0.37, p 0.001) and negatively for arm fat mass (r = -0.4, p 0.001, r = -0.32, p = 0.001) respectively, there were no correlations with anthropometric derived estimates of upper arm muscle or fat.In CKD patients, segmental MFBIA measurements of the arm, but not those derived from anthropometric measurements demonstrate gender differences and correlate with arm muscle strength, whereas there were no such correlations with anthropometric estimates of upper arm muscle or fat.

Introduction: the aim of this study was to assess the relationship between ultrasonographic hand muscle thickness measurements and hand muscle strength in patients who underwent median or ulnar nerve reconstruction. Methods: in this prospective, cross-sectional study, intrinsic hand muscle thicknesses were measured using ultrasound with a 4- to 13-MHz linear-array probe. Measurements of hand strength were performed using a dynamometer and a pinchmeter. Results: in the median nerve group (n = 11), a moderate correlation (r = 0.694; P =.018) was observed between lateral pinch strength and transverse thenar thickness. In the ulnar nerve group (n = 11), longitudinal thenar thickness below the flexor pollicis longus tendon was moderate to highly correlated with pinch and handgrip strengths (r = 0.726-0.893; P, NA

The objective of the study was to observe the change in Pinch Strength (PS) of arteriovenous fistula (AVF) arm and non-AVF arm before and after haemodialysis (HD). A total of 31 patients (21 Male and 10 Female) undergoing HD during January and February 2020 at a trust hospital were selected through purposive sampling. Mean PS was calculated from the measurements taken using the Jamar digital pinch gauge with an interval of five seconds between each measurement. Paired sample T-test was applied using SPSS 20. The mean PS values for AVF arm when compared before and after the session were 3.64 ±1.01 and 2.87 ±1.20 kgs (p

The objective of this study was to elucidate the association between unaffected hand function and cognitive impairment and to determine whether the cognitive screening test can be a predictor of unaffected upper limb function in patients with unilateral subcortical strokes. A retrospective study of 37 patients with unilateral first-ever subcortical stroke was conducted through a review of medical records. The unaffected hand function and cognitive screening tests were measured upon admission to the neurorehabilitation unit and then 4 weeks later at discharge. The relationship between unaffected hand function and cognitive function was investigated with multiple linear regression analysis. Comparing the initial evaluation of unaffected hand function and cognitive function with the evaluation at discharge, cognitive function improved significantly at discharge; however, grip strength and dexterity of the unaffected hand were stationary except for three-point pinch strength, tip pinch strength, and finger tapping speed. The Montreal cognitive assessment (MoCA) score was found to be a significant predictor of unaffected grip strength (R2 = 0.33, P = 0.004) and three-point pinch strength (R2 = 0.16, P = 0.04) at discharge and the Frontal Assessment Battery (FAB) score to be a predictive value of the unaffected finger tapping test (R2 = 0.46, P < 0.001) at discharge. In subcortical stroke patients with low MoCA and FAB scores, clinicians must ensure that patients participate in rehabilitation therapy including bimanual activity with careful attention to the patient's unaffected hand function.

ObjectiveTo evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.DesignSystematic review and meta-analysis.MethodsWe used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.Eligibility criteriaRCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.Results30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.ConclusionsLow and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.PROSPERO registration numberCRD42018082703.

Objectives The present study aims to describe a new percutaneous technique for the reconstruction of the ulnar collateral ligament of the metacarpophalangeal joint of the thumb with a tendon graft, and to evaluate the functional outcomes and stability six months postoperatively. Material and methods The percutaneous ligamentoplasty technique was performed with a palmaris longus tendon graft and tenodesis screws in 6 patients with ulnar instability of the thumb (> 30° degrees of radial deviation) for more than 6 weeks. Range of motion, grip strength, and pinch strength (lateral/key pinch, tip pinch, and palmar pinch) were assessed in comparison to the contralateral limb, as well as the Quick Disabilities of the Arm, Shoulder and Hand (DASH) score. Results At 6 months, the joint movement was of 100%, the grip strength was of 94.8%, the key pinch was of 95%, the palmar pinch was of 85.7%, and the tip pinch was of 93.5% compared to the contralateral limb. The internal tilt was of 14° compared to 9° at the contralateral limb. The Quick DASH score decreased from 24.2 to 2.6 points. Conclusion We devised this versatile surgical procedure to obtain early mobility with the advantages related to the percutaneous techniques.

BACKGROUND Chronic kidney disease (CKD) patients commonly report muscle weakness and fatigue. Losing muscle mass increases mortality. Accordingly, we aimed to determine the main factors associated with loss of muscle mass and muscle weakness. METHODS Anthropometric measurements were made in CKD patients attending a specialised clinic, along with hand grip strength (HGS), pinch strength (PS) and body composition (muscle mass and fat mass), using segmental bioimpedance assessment. RESULTS We reviewed the results of 161 CKD patients; 105 male (65.2%), mean (SD) age 70.3 (15) years, body mass index (BMI) 28.8 (6.7) kg m-2 . In multivariable models, both HGS and PS were independently negatively associated with age [standardised β (St β) = 0.35; 95% confidence limits (CL) = -0.32 to -0.14; St β = 0.38; 95% CL = -0.65 to -0.02; P

Dysgraphia and difficulty in activities of daily living skill are well documented in the research database as impairments affecting children with developmental coordination disorder. Pinch and grip strength has a predominant role in various activities of daily living skills, and a child can fulfil the playing skill only with good pinch and grip strength. To estimate hand strength evolution difference in children with developmental coordination disorder and to analyze the correlations in grip and pinch strength, handwriting and its components, and activities of daily living skills in children with and without developmental coordination disorder. Twenty children were selected and assigned into two groups, typically developing children and children with DCD. Each child was evaluated with pinch and grip strength, handwriting speed and legibility, pencil grip, and levels of performance in functional skills. When considering the strength development pattern, there exists a similar trend in children with and without DCD. Grip strength is having a perfect correlation with pencil control in both children with and without DCD. Handwriting is poor in the children with DCD but not in children without DCD. This study provides evidence that grip and pinch strength are important components when considering therapeutic intervention for enhancing handwriting skill in children with DCD.

Inclusion body myositis is the most commonly acquired myopathy after the age of 45. The slowly progressive and heterogeneous disorder is a challenge for measuring clinical trial efficacy. One current method for measuring progression utilizes the Inclusion Body Myositis-Functional Rating Scale. We have found that the upper extremity domain scores in the Inclusion Body Myositis-Functional Rating Scale do not consistently change until there is extreme loss of grip and finger flexor strength. Therefore, we performed a cross-sectional observational study of 83 inclusion body myositis patients and 38 controls recruited at the 2019 Annual Patient Conference of The Myositis Association. We evaluated new Inclusion Body Myositis Patient-Reported Outcome measures for upper extremity function modified from the NIH Patient-Reported Outcomes Measurement Information System as well as pinch and grip strength. We found that Patient-Reported Outcome measures hand-function have a higher correlation with pinch and grip strength than the Inclusion Body Myositis-Functional Rating Scale.

Question In people with bone and soft tissue injuries of the wrist, hand and/or fingers, do feedback-guided exercises performed on a tablet touchscreen hasten return to work, reduce healthcare usage and improve clinical recovery more than a home exercise program prescribed on paper? Design Randomised, parallel-group trial with concealed allocation, assessor blinding and intention-to-treat analysis. Participants Seventy-four workers with limited functional ability due to bone and soft tissue injuries of the wrist, hand and/or fingers. Intervention Participants in the experimental and control groups received the same in-patient physiotherapy and occupational therapy. Participants in the experimental group received a home exercise program using the ReHand tablet application, which guides exercises performed on a tablet touchscreen with feedback, monitoring and progression. Participants in the control group were prescribed an evidence-based home exercise program on paper. Outcome measures The primary outcome was the time taken to return to work. Secondary outcomes included: healthcare usage (number of clinical appointments); and functional ability, pain intensity, and grip and pinch strength 2 and 4 weeks after randomisation. Results Compared with the control group, the experimental group: returned to work sooner (MD –18 days, 95% CI –33 to –3); required fewer physiotherapy sessions (MD –7.4, 95% CI –13.1 to –1.6), rehabilitation consultations (MD –1.9, 95% CI –3.6 to 0.3) and plastic surgery consultations (MD –3.6, 95% CI –6.3 to –0.9); and had better short-term recovery of functional ability and pinch strength. Conclusion In people with bone and soft-tissue injuries of the wrist, hand and/or fingers, prescribing a feedback-guided home exercise program using a tablet-based application instead of a conventional program on paper hastened return to work and improved the short-term recovery of functional ability and pinch strength, while reducing the number of required healthcare appointments. Trial registration ACTRN12619000344190

Background Tendon avulsion at the musculotendinous junction caused by digit avulsion amputation is still a challenging problem. We aimed to compare the tendon functional outcomes of two repair methods for tendon avulsion rupture at the musculotendinous junction in patients with complete thumb avulsion amputations. Methods A retrospective study was performed to evaluate patients with complete thumb avulsion amputations whose tendons were repaired through reattachment to muscle (group I) or tendon transfer (group II) between July 2008 and October 2019. Outcomes of total range of motion, pinch strength, grip strength and reoperation rate were included. Results A total of 23 patients met the inclusion criteria, with a mean follow-up of 16.6 ± 4.2 months. Total active range of motion was comparable between groups I and II (P = 0.095). Pinch strength of group I was lower than group II (P = 0.001). The result of grip strength was found to be similar (P = 0.075). In addition, there was no significant difference in reoperation rate (P > 0.05). Conclusion Tendon transfer can attain higher pinch strength for replantation of thumb avulsion amputations. It is recommended for patients with jobs that demand higher strength.

The objective of this study was to investigate the effect of serious games on hand muscle strength and functionality in a series of cases with ulnar nerve damage. Two patients were included in this 16-week intervention study using biofeedback. Electromyography electrodes and dynamometers were used in treatment. Functionality was assessed by Rosen and Lundborg score, Disabilities of the arm, shoulder and hand (DASH) questionnaire and International Classification of Functioning, Disability and Health (ICF). Grip and pinch strength were assessed by dynamometers. Results revealed an increase in sensory domain of Rosen and Lundborg score of the two patients. Patients increased values from the DASH questionnaire; however, they got better results with ICF. Grip strength of the two patients increased; pinch strength varied between patients; key pinch had the best results. Serious games can be effective to enhance hand strength and improve functionality in patients with ulnar nerve damage.

Objective The objective was to investigate whether muscle strength in the nonaffected and affected upper extremities (UEs) in children (7–12 years) with unilateral spastic cerebral palsy (USCP) differs from that in children with typical development (TD). Methods A cross-sectional study design was used. Isometric arm strength (wrist flexion, wrist extension with flexed and extended fingers, elbow flexion/extension) was assessed in 72 children (mean age = 9.3 [SD = 1.9] years) with USCP, and isometric grip/pinch strength was assessed in 86 children (mean age = 9.3 [SD = 1.8] years) with USCP. Arm/grip/pinch strength was assessed in 120 children (mean age = 9.5 [SD = 1.7] years) with TD. Arm strength was measured with a hand-held dynamometer, and grip/pinch strength was measured with a calibrated, modified (digitized) grip dynamometer and a pinch meter. The nonaffected UE of children with USCP was compared with the preferred UE of children with TD because both sides represent the preferred UE. The affected UE was compared with the nonpreferred UE of children with TD, as both sides represent the nonpreferred UE. Results In all measurements except for grip strength of the preferred UE, children with USCP were weaker than children with TD. Conclusions In children with USCP, muscle strength weakness exists in both UEs. Impact When unimanual or bimanual ability limitations are present in children with unilateral cerebral palsy, investigation of the muscle strength of the nonaffected UE should be part of the assessment.

Background: Patients with hand eczema often describe symptoms such as pain, clumsiness and difficulty flexing their fingers, thus impairing the function of the hand. Objective: The aim of this study was to investigate whether hand eczema is associated with a measurable impairment of hand strength and dexterity. We also studied the relationship between hand function and the ability to perform activities of daily living (ADL), pain level and quality of life measured with the Dermatology Life Quality Index (DLQI). Methods: Twenty-one participants with ongoing hand eczema were examined with well-established methods for measuring hand grip strength, pinch strength and dexterity. A questionnaire was designed to investigate perceived ability to perform ADL. The participants were also asked to grade their current pain level, and the DLQI was used to assess the participants' quality of life. A group of 12 participants was reinvestigated when healed. Results: The participants demonstrated a significant improvement in all functional tests when healed. There was a strong correlation between ADL and both dexterity and hand grip strength. There was also a strong correlation between ADL and pain. All participants reported some difficulty performing ADL. Conclusions: Our results suggest that ongoing hand eczema may lead to a measurable decrease of strength and dexterity of the hand, leading to an impairment of the ability to perform ADL and consequently to a poorer quality of life.

Background: Guitarists use complex and different movement patterns in both hands simultaneously. Applying pressure on the strings and strumming both require good strength whereas playing the melody on the fret-board demands good proprioception. There is a need to find out if guitarists perform functionally well with respect to pinch strength and proprioception which are prerequisites for playing the guitar. Therefore, the aim of the study is to assess and compare finger proprioception and pinch strength in amateur and professional guitarists. Methodology: A cross sectional study was conducted on 50 amateur and 50 professional guitarists from Mumbai. A self-made questionnaire including their demographic data was asked to be filled. Proprioception was measured using the pinch aperture proprioception device and lateral pinch strength was measured using the Jamar® Hydraulic Pinch Gauge. The average of 3 trials was taken for finger proprioception and lateral pinch strength. The data obtained was then taken for further analysis. Result: Professional guitarists had better finger proprioception (p value = 0.0001 for both right & left hands) and lateral pinch strength (p value =0.0159, 0.0001 for the right & left hand respectively) than amateur guitarists. Also, the left hand had better finger proprioception (p value

OObjective: Force sense is an aspect of proprioception, which is most commonly assessed by reproducing a percentage of maximal voluntary isometric contraction. Exercise improves other aspects of proprioception such as joint position sense and kinesthesia, but there are contradictory findings regarding the effects of exercise on force sense. The purpose of this study is to assess the effects of long-term weightlifting training on pinch force sense of elite adolescent female athletes. Materials and Methods: Maximum key and tip pinch strength of 25 elite female adolescent weightlifters and 22 sedentary peers were measured. Participants were asked to press the pinchmeter with 50% of their maximal strength 3 times while looking at the scale and try to learn how much force they apply. Participants then tried to reproduce 50% of their maximum key and tip pinch strength without any visual feedback 3 times. Absolute error, constant error, root mean square error and coefficient of variation were calculated and these values were normalized by dividing to the target values. Accuracy was evaluated by absolute error and root mean square error; directionality of errors was evaluated by constant error and the precision was evaluated by coefficient of variation. Results: Weightlifter adolescents had higher key and tip pinch strength values compared to sedentary (p=0.03 and p=0.02, respectively). Normalized absolute error was lower in weightlifters in comparison with sedentary in both key and tip pinch force sense (p

Background The relationship between mild cognitive impairment (MCI) and pinch strength in patients with cardiovascular disease is unclear. The purpose of the present study was to examine the associations among MCI and pinch strength and to determine a pinch strength cut-off value for use in the assessment of MCI. Methods We conducted a cross-sectional study of 135 patients with cardiovascular disease but without probable dementia. MCI was estimated with the Japanese version of the Montreal Cognitive Assessment. We classified patients into the normal cognitive group and MCI group and compared their clinical characteristics, handgrip strength, and pinch strength. The relation between MCI and pinch strength was clarified with logistic regression analysis, and the cut-off value for three-fingered pinch strength was determined by receiver operating characteristic curve analysis. Results The incidence of MCI was 37.0 %. Significant differences between the two groups were identified for age, body mass index, hemoglobin, estimated glomerular filtration rate, albumin, dyslipidemia, use of nitrates, educational background, handgrip strength, and pinch strength. After multivariate analysis, three-fingered pinch strength was significantly associated with MCI (odds ratio 0.77, p = 0.02). The cut-off value of three-fingered pinch strength for predicting MCI was 6.75 kgf (area under the curve = 0.71; p Conclusions Pinch strength was one independent factor significantly associated with MCI in patients with cardiovascular disease. The determination of a cut-off value for three-fingered pinch strength that can predict MCI may be one important factor in the early screening for MCI in the daily clinical setting.

Study design: Cross-sectional and clinical measurement. Objective: To evaluate upper extremity function and its relation to the curve pattern in idiopathic scoliosis. Summary of background data: Postural alterations and trunk distortions—caused by three-dimensional deformity itself in idiopathic scoliosis—may lead to functional changes in the upper extremity of subjects. Methods: Handgrip, pulp and lateral pinch strengths, hand dexterity, hand reaction time, coordination of upper extremity, upper extremity performance, throwing accuracy, and self-reported upper extremity disability were evaluated in 96 subjects. These subjects were divided into 3 groups: 47 with main thoracic curve pattern scoliosis (Lenke type 1), 31 with thoracolumbar/lumbar curve pattern scoliosis (Lenke type 5), and 18 unaffected (healthy control). Comparisons were performed between these three groups. Results: The thoracic scoliosis group showed a significant decrease in concave lateral pinch strength, concave hand dexterity of turning, coordination of the upper extremities, and concave hand reaction time than the thoracolumbar/lumbar scoliosis group (p < 0.05). Bilateral handgrip strengths decreased in thoracic scoliosis group when compared to healthy controls. Healthy individuals demonstrated greater throwing accuracy than individuals with scoliosis. Conclusions: Upper extremity function was found to be affected based on the curve pattern. Individuals with main thoracic curves are likely to have deteriorated upper extremity function, especially for hand-specific motor skills, on the concave side, when compared to lumbar curves and healthy controls. Level of evidence: Level III. © 2020, Scoliosis Research Society.

Objectives In a longitudinal case–control observational study, we evaluated the benefits of a self-management programme for hands developed for patients with SSc. Methods Patients with SSc included in the intervention group (IG) received a concise self-management programme with emphasis on hand exercises and were evaluated during 24 weeks regarding hand pain, hand function, range of motion, grip and tip and key pinch strength. Results were compared with a control group (CG) with no intervention using an analysis of variance for repeated measures with variables transformed into ranks (P ≤ 0.05). Effect sizes were calculated using Cohen’s test. Results Of 90 patients who were evaluated, seven were excluded at enrolment and 26 were excluded during the follow-up. Data from 57 subjects (IG 40, CG 17) were used for analysis. Groups were similar at baseline, except for the Scleroderma HAQ and tip and key pinch strength. Outcome improvements were noted only in the IG (P ≤ 0.05, large effect size). In the CG, variables did not change or had even worsened (hand grip strength and finger motion). Conclusions This self-management programme based on hand exercises for SSc resulted in pain reduction and hand function, strength and range of motion improvement. It can be a simple and useful intervention, especially when a regular rehabilitation programme is not available.

Objectives This study aims to review our reconstruction method to treat chronic grade 3 thumb metacarpophalangeal (MP) joint radial collateral ligament (RCL) tears using free tendon grafts. Patients and methods Thirteen male patients (mean age 41 years; range, 20 to 67 years) who received a free tendon graft to treat chronic grade 3 thumb MP joint RCL injury between May 2016 and July 2018 were evaluated prospectively. Patients with incomplete bone maturation (n=1), those who had additional injuries in the same extremity (n=1), and those who had previously undergone surgery on the same extremity (n=1) were excluded. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire was used for functional evaluation and the visual analog scale (VAS) was also used for pain evaluation. Results The decrease in DASH (p=0.008) and VAS (p=0.03) scores and the increase in grip (p=0.031) and pinch strength (p=0.006) between the preoperative and final follow-up values were statistically significant. No ulnar deviation was observed in X-rays at the final examination, nor was MP joint radial instability observed under ulnar stress during clinical examinations. In two patients, 1 and 1.5 mm palmar subluxation was observed at final examination. The other 11 patients had no palmar subluxation at final examination. Conclusion Although ours is a more complicated method compared to other reconstruction approaches, we think that it is a suitable alternative for achieving joint stability and good functional results.

The RegJoint™ (Scaffdex Oy, Finland) implant is a bio-absorbable poly-L/D-lactide implant which acts as a temporary support in resected joint spaces. It can be used in base of thumb surgery as a spacer to prevent first metacarpal subsidence. However, high rates of adverse tissue reactions and bone osteolysis have been reported recently by one group. The objective of this study was to investigate the outcome of patients treated in our institution with this implant. Patients underwent a postoperative clinical and radiological assessment. The QuickDASH questionnaire, Patient Evaluation Measure (PEM) and a visual analogue scale for pain assessment were used. Grip strength, key pinch, pinch strength, thumb palmar and radial abduction and opposition were measured. Trapeziometacarpal height was used to evaluate thumb shortening compared with the preoperative value. Periprosthetic bone-erosion of the trapezium and metacarpal were measured. Subluxation of the joint was evaluated by measuring the step-off between the radial edge of the trapezium and the base of the first metacarpal bone. Twenty-two patients from 2013-2016 were included. There were no postoperative wound complications. There was no significant difference in grip strength, key pinch or pinch between the operated and the contralateral hand. There was no significant difference in the trapeziometacarpal height, trapezial height or the degree of subluxation pre-or post-operatively. Contrary to recent reports, we did not find any adverse soft tissue reactions or significant bone erosion. There was no significant change in hand function. We consider the RegJoint™ a useful adjunct in the management of a select cohort of patients with base of thumb arthritis.

Background: The purpose of this study is to describe our technique of thumb ulnar collateral ligament (UCL) repair with suture tape augmentation and to evaluate the short-term outcomes in our initial series of patients treated with this method of repair.Methods: Patients with minimum one-year follow up after isolated UCL repair with suture tape augmentation were contacted for clinical evaluation, radiographs, and postoperative outcome questionnaires, including the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire and study-specific questions. Thirteen of 15 (87%) consecutive patients who were treated using this method of repair were available for follow-up, 9 with acute tears and 4 with chronic tears.Results: Average post-operative thumb metacarpophalangeal (MCP) and interphalangeal (IP) joint range-of-motion (ROM) was 0–57.5° and 0–71°, respectively, for chronic tears and 2.2–53.9° and 0–71°, respectively, for acute tears. Average grip and pinch strength relative to the unaffected hand was 102% and 84%, respectively, among patients with chronic tears and 103.3% and 88.7%, respectively, among those with acute tears. All patients demonstrated stability with a firm endpoint, relative to the unaffected thumb. The average QuickDASH score among all patients was 11.9 for the disability/symptom module, 0 for the sport module and 16.5 for the work module. Stiffness was reported among 4 patients and no patient suffered wound-related issues or other complications.Conclusions: Thumb UCL repair with suture tape augmentation demonstrates short-term outcomes comparable to what has been reported for other methods of repair. It may potentially allow for an expedited recovery and rehabilitation process.

Cross-sectional research. To objectively evaluate grip force (GF) control while holding a freely movable object in individuals with cervical myelopathy (CM). Harunaso Hospital, Takasaki, Japan. We studied 52 hands from 26 individuals with CM. Participants performed a grip-and-lift task by pulp pinch using the thumb and index finger before surgery. We monitored individual finger GF (N) during the first 3 s while lifting and holding an object. Correlations between the GF and other clinical tests were evaluated. A multiple stepwise regression analysis was used to examine the contribution of the GF to the severity of clinical symptoms. Thumb GF was negatively correlated with the 10-s test (rs = −0.32), and index finger GF was positively correlated with its cutaneous pressure threshold (rs = 0.34). Multiple regression for the severity of upper extremity symptoms revealed that the model including the GF had a larger adjusted R2 and a lower AIC value than that of conventionally used clinical tests. These results suggested that the assessment of individual finger GF control could provide an indicator of the clinical severity of upper extremity in individuals with CM.

Objectives: To compare physical activity, postural stability, and muscle strength in Saudi adolescents with normal and poor sleep quality. Methods : This cross-sectional study investigated 62 Saudi adolescents between December 2017 and April 2018 at Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. Participants were classified into 2 equal groups; one with normal sleep (NS) and the other with poor sleep (PS). TecnoBody balance system was used to measure postural stability, ActiGraph to assess physical activity, and hand dynamometer and pinch gauge to assess hand grip and key pinch strength respectively. Results : At low platform stability, PS group showed poorer postural stability indices than NS group either with eyes opened or closed ( p less than 0.05). ActiGraph data revealed that the physical activity parameters including the total steps count, total activities count, activity rate, and the vigorous activity time were significantly lower in PS group ( p less than 0.05). The PS group had significantly more total sedentary time than the NS group. Muscle strength parameters did not show any significant difference between groups ( p greater than 0.05). Conclusion : Poor sleep significantly impaired postural stability and physical activity in Saudi adolescents. However, poor sleep had no effect on their isometric muscle strength. Saudi Med J 2020; Vol. 41 (1): 94-97 doi: 10.15537/smj.2020.1.24761 How to cite this article: Al-Rasheed AS, Ibrahim AI. Does the poor sleep quality affect the physical activity level, postural stability, and isometric muscle strength in Saudi adolescents? A comparative study. Saudi Med J . 2020 Jan;41(1):94-97. doi: 10.15537/smj.2020.1.24761.

الملخص: أهداف البحث: إن قوة القبضة مهمة للاستقلال بالرعاية الذاتية ومؤشر على الانخفاض الوظيفي. هدفت هذه الدراسة إلى تحديد ما إذا كان الأفراد الأصحاء سيظهرون قبضة لليد وقوة قرصة مختلفة: أولا، عند اختبارهما في ثلاثة أوضاع مختلفة للذراع؛ وثانيا، عند المقارنة بين اليد المهيمنة واليد غير المهيمنة. طرق البحث: تم استقطاب، وبصورة متتابعة، ما مجموعه ٦١ من طلاب الجامعة الذكور من ذوي اليد اليمنى المهيمنة، الذين تتراوح أعمارهم بين ١٩ و٢٣ سنة من كلية علوم التأهيل الطبي. أُخذت القياسات عن طريق ثلاثة من الباحثين. ضُبِط مقبض ''جامار'' لقياس القبضة اليدوية على الموضع الثاني لجميع الفحوصات. وتم توجيه المشاركين للضغط على المقبض اليدوي في حالة انثناء الكوع ٩٠ درجة، وحالة انحناء الكتف ٩٠ درجة، وحالة الذراع المتدلية. فيما يتعلق بقوة القرصة، كان على كل مشارك أن يضغط على لوحة الإبهام مقابل الجانب الوحشي للعظمة الوسطى للسبابة. وتم قياس قوة القرصة من نفس المواضع المستخدمة لقياس قوة قبضة اليد. أُخفيت النتائج عن المشاركين. النتائج: لم تُظهر قبضة اليد وقوة القرصة تأثيرا كبيرا. كما أنه لم تكن هناك فوارق ذات قيمة عند مقارنة قوة قبضة اليد اليمنى واليسرى. إلا أن قوة القرصة أظهرت زيادة كبيرة لصالح اليد المهيمنة. الاستنتاجات: يمكن للأطباء اختيار أي موضع للطرف العلوي لقياس قبضة اليد وقوة القرصة. أظهرت هذه الدراسة أنه يجب على الأطباء الحفاظ على، واستعادة درجة قريبة جدا من قبضة اليد وقوة قرصة الأيدي المهيمنة وغير المهيمنة لتحسين وظيفة الأيدي. Abstract: Objective: Grip strength is important for independent self-care and is a predictor of functional decline. This study aimed to determine if healthy individuals would demonstrate different hand-grip and key-pinch strengths at three different arm positions and in comparisons between dominant and non-dominant hands. Methods: A total of 61 right-hand–dominant male college students aged 19–23 years were consecutively recruited from the College of Medical Rehabilitation Sciences. Three researchers performed the measurements. All tests were performed with the JAMAR® hand-grip dynamometer handle set in its second position. Participants were instructed to squeeze the handle of the hand-grip dynamometer in the 90° elbow flexion, 90° shoulder flexion, and arm dangled positions. For assessment of key-pinch strength, every participant had to squeeze the thumb pad against the lateral aspect of the middle phalanx of the index finger. Key-pinch strength was measured in the same positions used for assessment of hand-grip strength. Participants were blinded for the outcome measurements. The significance level was set at p