The relationship between the Patient-rated Ulnar Nerve Evaluation and the common impairment measures of grip strength, pinch strength, and sensation

Published:October 16, 2014DOI:


      Study design

      Prospective cohort study.


      Grip strength, pinch strength, and sensory threshold are common evaluations used on a daily basis. Identifying how these variables relate to function for patients allows these assessments to be used for screening to identify who may benefit from surgical intervention, and provides valuable information about what impairments patients think are important with respect to functional use of their upper extremity. Therapists can use this information to focus rehabilitation programs on the most important impairments.


      To evaluate the relationship between the Patient-rated Ulnar Nerve Evaluation (PRUNE) and impairment measures of grip strength, pinch strength, and one-point sensory threshold.


      Data was prospectively collected from 77 patients before surgery and during regular time points for 2 years following surgery. Patients completed the PRUNE, grip and pinch strength measures, and a one-point sensory threshold evaluation. Correlations between these variables were calculated at baseline, 2 years after surgery, and for change scores during the 2-year follow up. A multiple regression analysis was used to determine the contribution of the impairment variables for determining functional change.


      Grip strength showed moderate, statistically significant correlation with PRUNE scores at both baseline (r = −0.38) and at two years (r = −0.29). There was also a statistically significant correlation between one point sensory threshold for the small finger at two years (r = 0.36), but not at baseline. Change in grip strength (r = −0.28) and pinch strength (r = −0.30) both demonstrated significant correlations with PRUNE change scores. Overall, changes in grip strength, pinch strength, and sensation accounted for 20% of the variance in PRUNE changes.


      Since grip strength was most highly correlated with PRUNE scores at baseline and at two years, rehabilitation programs that target grip strengthening is supported. While neither grip nor pinch strength were significant contributors to the regression when used together, each showed significant contributions to PRUNE variability when used in the model independently. Therefore, a combination of grip and pinch strengthening may be important during rehabilitation for improving functional results in patients that undergo surgical intervention for cubital tunnel syndrome.

      Level of evidence



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      JHT Read for Credit

      Quiz: #338

      Record your answers on the Return Answer Form found on the tear-out coupon at the back of this issue or to complete online and use a credit card, go to There is only one best answer for each question.
      • #1.
        In 2013 the PRUNE was described by
        • a.
          Szekeres and King
        • b.
          Bell and Fess
        • c.
          MacDermid and Grewal
        • d.
          Osterman and Skirven
      • #2.
        Sensory testing was performed utilizing
        • a.
          one-point sensory threshold
        • b.
          moving 2 point discrimination (M2PD)
        • c.
          Semmes Weinstein monofilament testing
        • d.
          Seddon 2 point discrimination
      • #3.
        Which measure showed the highest correlation with the PRUNE
        • a.
          9 hole peg test
        • b.
          pinch strength
        • c.
          sensory testing
        • d.
          grip strength
      • #4.
        Study subjects included patients who had undergone
        • a.
          cubital tunnel decompression
        • b.
          ulnar nerve transposition
        • c.
          either cubital tunnel decompression or ulnar nerve transposition
        • d.
          no surgery
      • #5.
        The correlation between the PRUNE and the common tests of ulnar nerve function suggests good validity of the PRUNE
        • a.
        • b.
      When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.