Scientific/Clinical Article| Volume 19, ISSUE 4, P393-402, October 2006

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Strength Measurements of the Intrinsic Hand Muscles: A Review of the Development and Evaluation of the Rotterdam Intrinsic Hand Myometer


      Numerous neurological diseases are accompanied by atrophy of the intrinsic muscles of the hand. Muscle strength testing of these muscles is frequently used for clinical decision making. Traditionally, these strength measurements have focused on manual muscle testing (MMT) or on grip and pinch strength dynamometry. We have developed a hand-held dynamometer, the Rotterdam Intrinsic Hand Myometer (RIHM), to measure this intrinsic muscle strength. The RIHM was designed such that it can measure a wide range of muscle groups, such as the abduction and adduction strength of the little finger and index finger, the opposition, palmar abduction (anteposition) and opposition strength of the thumb, and intrinsic muscles of the fingers combined in the intrinsic plus position. We found that the reliability of RIHM measurements in nerve injury patients was comparable to grip and pinch strength measurements and is appropriate to study the functional recovery of the intrinsic muscles of the hand in isolation. We have applied the RIHM in a recent study on the long-term outcome of muscle strength in patients with ulnar and median nerve injuries and found that while recovery of grip and pinch strength was relatively good, recovery of the ulnar nerve innervated muscles measured with the RIHM was poor. This poor recovery could not be detected with manual muscle strength testing or with grip and pinch dynamometry. We conclude that the RIHM provides an accurate clinical assessment of the muscle strength of the intrinsic hand muscles that adds valuable information to MMT and grip and pinch dynamometry.
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      JHT Read for Credit

      Quiz: Article #041

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue. There is only one best answer for each question.
      • #1.
        THE ASHT recommends when doing a MMT that:
        • a.
          all scores from 0 to 5 be used.
        • b.
          only the scores of 0-3 be used because higher muscle strengths are not appropriately tested with this scale.
        • c.
          an EMG must also be used to confirm validity.
        • d.
          standard scoring technique is appropriate, except for thumb intrinsics which are unreliable.
      • #2.
        The RIHM devise is:
        • a.
          mounted on the table and made of durable aluminum.
        • b.
          ergonomically appropriate because it is constructed of materials that mold to the hand.
        • c.
          recommended for home use by the patient as a form of biofeedback.
        • d.
          hand held and made of light weight plastic.
      • #3.
        The RIMH:
        • a.
          is a far different approach to testing the intrinsics than MMT.
        • b.
          is considered by the ASHT to be the Gold Standard for testing the strength of the intrinsics.
        • c.
          uses an approach similar to MMT & can be used to test all the intrinsics of the hand.
        • d.
          eliminates the need for EMG studies in evaluating the intrinsics.
      • #4.
        The reliability of the RIMH was:
        • a.
          94 for interrater.
        • b.
          94 for intrarater.
        • c.
          74 for both intra & interrater.
        • d.
          not reported in this study.
      • #5.
        The study suggests as illustrated in the 1st case study that:
        • a.
          while grip & pinch scores may improve, intrinsic strength may not improve at a similar rate.
        • b.
          intrinsic strength routinely improves at a similar rate to grip & pinch.
        • c.
          intrinsic strength often improves at a greater rate than grip & pinch.
        • d.
          lumbricals typically improve at a faster rate than the interossei.
      When submitting to the HTCC for recertification, please batch your JHT RFC certificates in groups of three or more to get full credit.