Full Length Article| Volume 36, ISSUE 1, P85-96, January 2023

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Flexion-extension strength of the index-thumb system in Italian population. A cross-sectional study to gather normative data


      • Pinch MVC (maximal voluntary contraction) is not correlated to dexterity
      • Pinch MVC and E-MVC (extension maximal voluntary contraction) values have different decline over ageing.
      • No difference in E-MVC (extension maximal voluntary contraction) was observed between hands
      • In heaviest occupations there is no difference in Palmar pinch MVC between hands
      • The anthropometric factor most correlated with pinch MVCs is height


      Study design

      Cross-sectional study.


      Flexion (Palmar Pinch, PP-MVC and Tip Pinch, TP-MVC) and extension (E-MVC) maximal voluntary contraction (MVC) of the index-thumb system offers a quick way to estimate the level of hands’ impairment in several musculoskeletal and neurologic conditions.

      Purpose of the Study

      This study established normative data of PP-MVC, TP-MVC, E-MVC in the Italian population and evaluated their correlation with hand dominance, anthropometric factors, dexterity and workload level.


      In our study, 303 healthy people (150F, 153M) were recruited. Participants performed PP-MVC, TP-MVC and E-MVC tests per hand, conducted by using a pinch-gauge. T-test was used to analyze MVC means between sexes and between hands. One-way ANOVA was conducted to compare MVC means in male and female samples stratified by age (18-29, 30-44, 45-59, 60-74, +75). Spearman's correlation analysis was performed to determine anthropometric variables, dexterity and workload level effects on MVCs.


      Medium-to-large effect sizes of age were shown in the majority of tasks. The 30 to 44 years and then +75 years age groups showed the highest and the lowest values, respectively, for both sex and both hands. Men were meanly 50% stronger, and the dominant hand showed higher values (6-10%). MVC-tests correlated moderately with weight and height weakly with dexterity and workload level.


      After 30 to 44 years, hand strength declines in line with the normal process of aging that also entails muscle fibers and the reduction of daily activities in older adults. In relative terms, E-MVC showed the highest strength loss in the over 75 seconds. The difference between sexes was higher in E-MVC than in flexion MVCs. E-MVC seems to depend more on musculoskeletal architecture that differs from women to men, according to the highest correlation between E-MVC and anthropometric variables. Only high workload levels impacted hand strength. In heaviest occupations, no PP-MVCs differences were observed between hands.


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        • Kjeken I
        • Dagfinrud H
        • Slatkowsky-Christensen B
        • et al.
        Activity limitations and participation restrictions in women with hand osteoarthritis: patients’ descriptions and associations between dimensions of functioning.
        Ann Rheum Dis. 2005; 64: 1633-1638
        • Rossettini G
        • Rondoni A
        • Schiavetti I
        • Tezza S
        • Testa M.
        Prevalence and risk factors of thumb pain in Italian manual therapists: an observational cross-sectional study.
        Work. 2016; 54: 159-169
        • Bae JH
        • Kang SH
        • Seo KM
        • Kim D-K
        • Shin HI
        • Shin HE.
        Relationship between grip and pinch strength and activities of daily living in stroke patients.
        Ann Rehabil Med. 2015; 39: 752-762
        • Pérez-Mármol JM
        • Ortega-Valdivieso MA
        • Cano-Deltell EE
        • Peralta-Ramírez MI
        • García-Ríos MC
        • Aguilar-Ferrándiz ME.
        Influence of upper limb disability, manual dexterity and fine motor skill on general self-efficacy in institutionalized elderly with osteoarthritis.
        J hand Ther. 2016; 29: 58-65
        • Cantero-Téllez R
        • Martín-Valero R
        • Cuesta-Vargas A
        Effect of muscle strength and pain on hand function in patients with trapeziometacarpal osteoarthritis. A cross-sectional study.
        Reumatol Clin. 2015; 11: 340-344
        • Palamar D
        • Er G
        • Terlemez R
        • Ustun I
        • Can G
        • Saridogan M.
        Disease activity, handgrip strengths, and hand dexterity in patients with rheumatoid arthritis.
        Clin Rheumatol. 2017; 36: 2201-2208
        • Yoo JS
        • Ahn J
        • Mayo BC
        • et al.
        Improvements in grip and pinch strength and patient-reported outcomes after anterior cervical discectomy and fusion.
        Clin Spine Surg. 2019; 32: 403-408
        • Wachter NJ
        • Mentzel M
        • Krischak GD
        • Gülke J.
        Quantification of hand function by power grip and pinch strength force measurements in ulnar nerve lesion simulated by ulnar nerve block.
        J Hand Ther. 2018; 31: 524-529
        • Mathiowetz V
        • Kashman N
        • Volland G
        • Weber K
        • Dowe M
        • Rogers S.
        Grip and pinch strength: normative data for adults.
        Arch Phys Med Rehabil. 1985; 66: 69-74
        • Ügurlu U
        • Özdogan H.
        Age- and gender-specific normative data of pinch strengths in a healthy Turkish population.
        J Hand Surg Eur Vol. 2012; 37: 436-446
        • Zieske L
        • Ebersole GC
        • Davidge K
        • Fox I
        • Mackinnon SE.
        Revision carpal tunnel surgery: a 10-year review of intraoperative findings and outcomes.
        J Hand Surg Am. 2013; 38: 1530-1539
        • Villafañe JH
        • Valdes K.
        Reliability of pinch strength testing in elderly subjects with unilateral thumb carpometacarpal osteoarthritis.
        J Phys Ther Sci. 2014; 26: 993-995
        • Fernández-de-Las-Peñas C
        • Cleland J
        • Palacios-Ceña M
        • Fuensalida-Novo S
        • Pareja JA
        • Alonso-Blanco C
        The effectiveness of manual therapy versus surgery on self-reported function, cervical range of motion, and pinch grip force in carpal tunnel syndrome: a randomized clinical trial.
        J Orthop Sports Phys Ther. 2017; 47: 151-161
        • Cooney 3rd, WP
        • An KN
        • Daube JR
        • Askew LJ
        Electromyographic analysis of the thumb: a study of isometric forces in pinch and grasp.
        J Hand Surg Am. 1985; 10: 202-210
        • Calder KM
        • Galea V
        • Wessel J
        • MacDermid JC
        • MacIntyre NJ.
        Muscle activation during hand dexterity tasks in women with hand osteoarthritis and control subjects.
        J Hand Ther. 2011; 24: 207-214
        • Valdes K
        • von der Heyde R.
        An exercise program for carpometacarpal osteoarthritis based on biomechanical principles.
        J Hand Ther. 2012; 25: 251-262
        • McGee C
        • O'Brien V
        • Van Nortwick S
        • Adams J
        • Van Heest A
        First dorsal interosseous muscle contraction results in radiographic reduction of healthy thumb carpometacarpal joint.
        J Hand Ther. 2015; 28: 375-380
        • Villafañe JH
        • Valdes K.
        Combined thumb abduction and index finger extension strength: a comparison of older adults with and without thumb carpometacarpal osteoarthritis.
        J Manipulative Physiol Ther. 2013; 36: 238-244
        • Trumble TE
        • Kahn U
        • Vanderhooft E
        • Bach AW.
        A technique to quantitate motor recovery following nerve grafting.
        J Hand Surg Am. 1995; 20: 367-372
        • Boatright JR
        • Kiebzak GM.
        The effects of low median nerve block on thumb abduction strength.
        J Hand Surg Am. 1997; 22: 849-852
        • Forget N
        • Piotte F
        • Arsenault J
        • Harris P
        • Bourbonnais D.
        Bilateral thumb's active range of motion and strength in de Quervain's disease: comparison with a normal sample.
        J hand Ther. 2008; 21: 276-284
        • Fournier K
        • Bourbonnais D
        • Bravo G
        • Arsenault J
        • Harris P
        • Gravel D.
        Reliability and validity of pinch and thumb strength measurements in de Quervain's disease.
        J Hand Ther. 2006; 19: 2-10
        • von Elm E
        • Altman DG
        • Egger M
        • Pocock SJ
        • Gøtzsche PC
        • Vandenbroucke JP.
        The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.
        J Clin Epidemiol. 2008; 61: 344-349
        • Stanczak EM
        • Stanczak DE
        • Templer DI.
        Subject-selection procedures in neuropsychological research: a meta-analysis and prospective study.
        Arch Clin Neuropsychol. 2000; 15: 587-601
        • Werle S
        • Goldhahn J
        • Drerup S
        • Simmen BR
        • Sprott H
        • Herren DB.
        Age- and gender-specific normative data of grip and pinch strength in a healthy adult Swiss population.
        J Hand Surg Eur Vol. 2009; 34: 76-84
        • Testa M
        • Rolando M
        • Roatta S.
        Control of jaw-clenching forces in dentate subjects.
        J Orofac Pain. 2011; 25: 250-260
        • Testa M
        • Geri T
        • Gizzi L
        • Petzke F
        • Falla D.
        Alterations in masticatory muscle activation in people with persistent neck pain despite the absence of orofacial pain or temporomandibular disorders.
        J Oral Facial Pain Headache. 2015; 29: 340-348
        • Testa M
        • Geri T
        • Gizzi L
        • Falla D.
        High-density EMG reveals novel evidence of altered masseter muscle activity during symmetrical and asymmetrical bilateral jaw clenching tasks in people with chronic nonspecific neck pain.
        Clin J Pain. 2017; 33: 148-159
        • Fess E
        • Moran C.
        American Society of Hand Therapists Clinical Assessment Recommendations.
        1st ed. The Society, Chicago1981
        • Mohammadian M
        • Choobineh A
        • Haghdoost A
        • Hasheminejad N.
        Normative data of grip and pinch strengths in healthy adults of Iranian population.
        Iran J Public Health. 2014; 43: 1113-1122
        • Salmaso D
        • Longoni AM.
        Problems in the assessment of hand preference.
        Cortex. 1985; 21: 533-549
        • Oldfield RC.
        The assessment and analysis of handedness: the Edinburgh inventory.
        Neuropsychologia. 1971; 9: 97-113
        • Papadatou-Pastou M
        • Ntolka E
        • Schmitz J
        • et al.
        Human handedness: a meta-analysis.
        Psychol Bull. 2020; 146: 481-524
        • Oxford Grice K
        • Vogel KA
        • Le V
        • Mitchell A
        • Muniz S
        • Vollmer MA
        Adult norms for a commercially available Nine Hole Peg Test for finger dexterity.
        Am J Occup Ther. 2003; 57: 570-573
        • Mathiowetz V
        • Weber K
        • Kashman N
        • Volland G.
        Adult Norms for the Nine Hole Peg Test of finger dexterity.
        Occup Ther J Res. 1985; 5: 24-38
      1. United States Department of Labor. United States Employment Service and the NCOAFC. Dictionary of Occupational Titles (DOT): Revised 4th Ed., 1991. Published online 2006. doi:10.3886/ICPSR06100.v1

        • Cohen J.
        A power primer.
        Psychol Bull. 1992; 112: 155-159
        • Cohen J.
        Statistical Power Analysis for the Behavioral Sciences.
        2nd ed. Routledge, New York, NY2013
        • McDowell I.
        Measuring Health: A Guide to Rating Scales and Questionnaires.
        3rd ed. Oxford University Press, New York, NY2006
        • Puh U.
        Age-related and sex-related differences in hand and pinch grip strength in adults.
        Int J Rehabil Res. 2010; 33: 4-11
        • Klum M
        • Wolf MB
        • Hahn P
        • Leclère FM
        • Bruckner T
        • Unglaub F.
        Normative data on wrist function.
        J Hand Surg Am. 2012; 37: 2050-2060
        • Izquierdo M
        • Ibañez J
        • Gorostiaga E
        • et al.
        Maximal strength and power characteristics in isometric and dynamic actions of the upper and lower extremities in middle-aged and older men.
        Acta Physiol Scand. 1999; 167: 57-68
        • Frontera WR
        • Hughes VA
        • Fielding RA
        • Fiatarone MA
        • Evans WJ
        • Roubenoff R.
        Aging of skeletal muscle: a 12-year longitudinal study.
        J Appl Physiol. 2000; 88: 1321-1326
        • Macaluso A
        • Nimmo MA
        • Foster JE
        • Cockburn M
        • McMillan NC
        • De Vito G.
        Contractile muscle volume and agonist-antagonist coactivation account for differences in torque between young and older women.
        Muscle Nerve. 2002; 25: 858-863
        • D'Antona G
        • Pellegrino MA
        • Adami R
        • et al.
        The effect of ageing and immobilization on structure and function of human skeletal muscle fibres.
        J Physiol. 2003; 552: 499-511
        • Narici MV
        • Maganaris CN
        • Reeves ND
        • Capodaglio P.
        Effect of aging on human muscle architecture.
        J Appl Physiol. 2003; 95: 2229-2234
        • Abate M
        • Di Iorio A
        • Di Renzo D
        • Paganelli R
        • Saggini R
        • Abate G.
        Frailty in the elderly: the physical dimension.
        Eura Medicophys. 2007; 43: 407-415
        • Faulkner JA
        • Larkin LM
        • Claflin DR
        • Brooks SV.
        Age-related changes in the structure and function of skeletal muscles.
        Clin Exp Pharmacol Physiol. 2007; 34: 1091-1096
        • Gilbertson L
        • Barber-Lomax S.
        Power and pinch grip strength recorded using the hand-held jamar dynamometer and B+L hydraulic pinch gauge: British normative data for adults.
        Br J Occup Ther. 1994; 57: 483-488
        • Nilsen T
        • Hermann M
        • Eriksen CS
        • Dagfinrud H
        • Mowinckel P
        • Kjeken I.
        Grip force and pinch grip in an adult population: reference values and factors associated with grip force.
        Scand J Occup Ther. 2012; 19: 288-296
        • Jeune B
        • Skytthe A
        • Cournil A
        • et al.
        Handgrip strength among nonagenarians and centenarians in three European regions.
        J Gerontol A Biol Sci Med Sci. 2006; 61: 707-712
        • Stegink Jansen CW
        • Simper VK
        • Stuart HGJ
        • Pinkerton HM.
        Measurement of maximum voluntary pinch strength: effects of forearm position and outcome score.
        J Hand Ther. 2003; 16: 326-336
        • Halpern CA
        • Fernandez JE.
        The effect of wrist and arm postures on peak pinch strength.
        J Hum Ergol (Tokyo). 1996; 25: 115-130
        • McCoy W
        • Dekerlegand J.
        Effect of the position of ulnar three digits on thumb to index tip to tip pinch strength.
        J Hand Ther. 2011; 24: 379
        • Imrhan SN
        • Rahman R.
        The effects of pinch width on pinch strengths of adult males using realistic pinch-handle coupling.
        Int J Ind Ergon. 1995; 16: 123-134
        • Binboğa E
        • Tok S
        • Catikkas F
        • Guven S
        • Dane S.
        The effects of verbal encouragement and conscientiousness on maximal voluntary contraction of the triceps surae muscle in elite athletes.
        J Sports Sci. 2013; 31: 982-988
        • Jung M-C
        • Hallbeck MS.
        Quantification of the effects of instruction type, verbal encouragement, and visual feedback on static and peak handgrip strength.
        Int J Ind Ergon. 2004; 34: 367-374
        • Crosby CA
        • Wehbé MA
        • Mawr B.
        Hand strength: normative values.
        J Hand Surg Am. 1994; 19: 665-670
        • Janssen I
        • Heymsfield SB
        • Wang ZM
        • Ross R.
        Skeletal muscle mass and distribution in 468 men and women aged 18-88 yr.
        J Appl Physiol. 2000; 89: 81-88
        • Wu R
        • Delahunt E
        • Ditroilo M
        • Lowery M
        • De Vito G.
        Effects of age and sex on neuromuscular-mechanical determinants of muscle strength.
        Age (Dordr). 2016; 38: 57
        • Ditroilo M
        • Forte R
        • Benelli P
        • Gambarara D
        • De Vito G.
        Effects of age and limb dominance on upper and lower limb muscle function in healthy males and females aged 40 to 80 years.
        J Sports Sci. 2010; 28: 667-677
        • Josty IC
        • Tyler MP
        • Shewell PC
        • Roberts AH.
        Grip and pinch strength variations in different types of workers.
        J Hand Surg Br. 1997; 22: 266-269
        • Petersen P
        • Petrick M
        • Connor H
        • Conklin D.
        Grip strength and hand dominance: challenging the 10% rule.
        Am J Occup Ther. 1989; 43: 444-447
        • Kunelius A
        • Darzins S
        • Cromie J
        • Oakman J.
        Development of normative data for hand strength and anthropometric dimensions in a population of automotive workers.
        Work. 2007; 28: 267-278
        • Angst F
        • Drerup S
        • Werle S
        • Herren DB
        • Simmen BR
        • Goldhahn J.
        Prediction of grip and key pinch strength in 978 healthy subjects.
        BMC Musculoskelet Disord. 2010; 11: 94
        • Guerra RS
        • Fonseca I
        • Pichel F
        • Restivo MT
        • Amaral TF.
        Hand length as an alternative measurement of height.
        Eur J Clin Nutr. 2014; 68: 229-233
        • Shim JH
        • Roh SY
        • Kim JS
        • et al.
        Normative measurements of grip and pinch strengths of 21st century Korean population.
        Arch Plast Surg. 2013; 40: 52-56
        • Alahmari KA
        • Silvian SP
        • Reddy RS
        • Kakaraparthi VN
        • Ahmad I
        • Alam MM.
        Hand grip strength determination for healthy males in Saudi Arabia: a study of the relationship with age, body mass index, hand length and forearm circumference using a hand-held dynamometer.
        J Int Med Res. 2017; 45: 540-548
        • Anila P
        • Prajakta G
        • Nikeeta G.
        An investigation into normative values for fine hand dexterity and its relation with pinch and grip strength among healthy young Indian adults.
        Int J Med Res Heal Sci. 2016; 5: 235-238

      JHT Read for Credit

      Quiz: # 930

      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.
        Statistical analysis consisted of
        • a.
        • b.
        • c.
          both a and b above
        • d.
          none of the above
      • # 2.
        The study sought to establish
        • a.
          normative data in an Italian population
        • b.
          normative data throughout Caucasian populations
        • c.
          normative data across ethnic populations
        • d.
          differences between normative data and data for a hand injured population
      • # 3.
        Functional muscle testing was performed for
        • a.
          tip pinch
        • b.
        • c.
          palmar pinch
        • d.
          all of the above
      • # 4.
        Men tested approximately ________ stronger than women
        • a.
        • b.
        • c.
        • d.
      • # 5.
        The difference between sexes was higher in extension than in flexion
        • a.
          not true
        • b.
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