Abstract
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.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Hand TherapyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Measuring the strength of the intrinsic muscles of the hand in patients with ulnar and median nerve injuries: reliability of the Rotterdam Intrinsic Hand Myometer (RIHM).J Hand Surg [Am]. 2004; 29: 318-324
- Intrarater reliability of manual muscle testing and hand-held dynametric muscle testing.Phys Ther. 1987; 67: 1342-1347
- Intrarater reliability of manual muscle test (Medical Research Council scale) grades in Duchenne's muscular dystrophy.Phys Ther. 1992; 72 (discussion 122–6): 115-122
- Manual muscle strength testing: intraobserver and interobserver reliabilities for the intrinsic muscles of the hand.J Hand Ther. 1995; 8: 185-190
- Assessment of functional outcome after nerve repair in a longitudinal cohort.Scand J Plast Reconstr Surg Hand Surg. 2000; 34: 71-78
- Measuring hand intrinsic muscle strength: normal values and interrater reliability.J Spinal Cord Med. 2004; 27: 460-467
- Overwork weakness in Charcot-Marie-Tooth disease.Arch Phys Med Rehabil. 2003; 84: 825-827
- Hand strength and fatigue in patients with hereditary motor and sensory neuropathy (types I and II).Arch Phys Med Rehabil. 2002; 83: 1274-1278
- The effect of long-distance bicycling on ulnar and median nerves: an electrophysiologic evaluation of cyclist palsy.Am J Sports Med. 2005; 33: 1224-1230
- Ulnar and median nerve palsy in long-distance cyclists. A prospective study.Am J Sports Med. 2003; 31: 585-589
- Handlebar palsy—a compression syndrome of the deep terminal (motor) branch of the ulnar nerve in biking.J Neurol. 2002; 249: 1441-1445
- Carpal tunnel syndrome in association with hand-arm vibration syndrome: a review of claimants seeking compensation in the Mining Industry.J Hand Surg [Br]. 2005; 30: 199-203
- Reduced muscle strength in abduction of the index finger: an important clinical sign in hand-arm vibration syndrome.Scand J Plast Reconstr Surg Hand Surg. 2003; 37: 365-370
- Hand muscle weakness in long-term vibration exposure.J Hand Surg [Br]. 2002; 27: 520-525
- Hand muscle pathology after long-term vibration exposure.J Hand Surg [Br]. 2004; 29: 431-437
- The musculoskeletal complications seen in type II diabetics: predominance of hand involvement.Clin Rheumatol. 2003; 22: 229-233
- A model instrument for the documentation of outcome after nerve repair.J Hand Surg [Am]. 2000; 25: 535-543
- Ulnar nerve repair.in: Gelberman R.H. Operative Nerve Repair and Reconstruction. J.B. Lippincott Comp, Philadelphia1991: 425-436
- The quest for better recovery from peripheral nerve injury: current status of nerve regeneration research.J Hand Ther. 1993; 6: 83-88
- The contribution of the intrinsic muscles to grip and pinch strength.J Hand Surg [Am]. 1999; 24: 64-72
- Manual muscle strength testing and dynamometry for bilateral ulnar neuropraxia in a surgeon.J Hand Ther. 1995; 8: 191-194
- Certain aspects of infantile paralysis with a description of a method of muscle testing.JAMA. 1916; 66
Zachary RB. Results of nerve suture. London, UK: Her Majesty's Stationary Office. Peripheral Nerve Injuries. Medical Research Council Report Series No. 282, 1954, pp. 354–88.
Medical Research Council. Special Report series no 282. London: Her Majesty's Stationary Office.
- Sensible manual muscle strength testing to evaluate and monitor strength of the intrinsic muscles of the hand: a commentary.J Hand Ther. 2001; 14: 273-278
- Measuring muscle strength.J Neurol. 1984; 231: 200-203
- A technique to quantitate motor recovery following nerve grafting.J Hand Surg [Am]. 1995; 20: 367-372
- Grip strength.in: Casanova J.S. Clinical Assessment Recommendations. American Society of Hand Therapists, Chicago1992: 41-46
- Grade 4 in manual muscle testing: the problem with submaximal strength assessment.Clin Rehabil. 1997; 11: 36-41
- Relationship between two measures of upper extremity strength: manual muscle test compared to hand-held myometry.Arch Phys Med Rehabil. 1992; 73: 1063-1068
- A numerical grading scale for peripheral nerve function.J Hand Ther. 1993; 6: 152-160
- Measurement of health outcomes following tendon and nerve repair.J Hand Ther. 2005; 18: 297-312
- Studies on the hand in ulnar nerve paralysis. A clinical–experimental investigation in normal and anomalous innervation.Acta Orthop Scand. 1966; 87: 61-86
- Studies on ulnar nerve compression neuropathies with a new computerised instrument—the intrins-o-meter.Scand J Plast Reconstr Surg Hand Surg. 1997; 31: 251-260
- Measurement of thumb abduction strength: normative data and a comparison with grip and pinch strength.J Hand Surg [Am]. 1997; 22: 843-848
- Quantitative abductor pollicis brevis strength testing: reliability and normative values.J Hand Surg [Am]. 2000; 25: 752-759
- A clinical study of forces generated by the intrinsic muscles of the index finger and the extrinsic flexor and extensor muscles of the hand.J Hand Surg [Am]. 1978; 3: 571-578
- Strength of the intrinsic muscles of the hand measured with a hand-held dynamometer: reliability in patients with ulnar and median nerve paralysis.J Hand Surg [Br]. 2000; 25: 560-565
- Reliability assessment of isometric knee extension measurements with a computer-assisted hand-held dynamometer.Arch Phys Med Rehabil. 1998; 79: 442-448
- Applying evidence on outcome measures to hand therapy practice.J Hand Ther. 2004; 17: 165-173
- Long-term outcome of muscle strength in ulnar and median nerve injury: comparing manual muscle strength testing, grip and pinch strength dynamometers and a new intrinsic muscle strength dynamometer.J Rehabil Med. 2004; 36: 273-278
- Sollerman hand function test. A standardised method and its use in tetraplegic patients.Scand J Plast Reconstr Surg Hand Surg. 1995; 29: 167-176
- Measurement error in grip and pinch force measurements in patients with hand injuries.Phys Ther. 2003; 83: 806-815
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.
- a.
- #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.
- a.
- #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.
- a.
- #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.
- a.
- #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.
- a.
When submitting to the HTCC for recertification, please batch your JHT RFC certificates in groups of three or more to get full credit.
Article info
Footnotes
The authors hereby state that they have no personal interest in the Rotterdam Intrinsic Hand Myometer.
Identification
Copyright
© 2006 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.
