Research Article| Volume 35, ISSUE 2, P254-260, April 2022

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Reliability of a novel technique to assess palmar contracture in young children with unilateral hand injuries

Published:April 28, 2022DOI:


      • Hand span and hand length measures have excellent reliability in young children
      • The mean between-hand difference in hand span and length in young children is 2 mm
      • The cut-off for normative difference in hand span is <9 mm and hand length is <6 mm



      Palmar contracture in young children can have significant developmental consequences. Despite this, objective techniques to measure palmar range of movement and quantify contracture in young children are limited.


      The purpose of this study was to determine the reliability of hand span and hand length measures in young children and to establish whether there is any association with age, sex and presence of a palmar burn injury in the reliability of these measures. The study also sought to determine the normative difference and establish a cut off value for the between-hand difference to identify loss of movement in 1 hand.

      Study design

      Cross sectional


      Forty-four children aged 0 to <5 years were recruited. Twenty-two children had a unilateral palmar burn injury and 22 did not have a palmar burn injury. Each child's hand span and hand length were measured 3 times. This was performed twice by the first assessor and once by the second assessor. Intraclass correlation coefficients were calculated to determine the intra-rater and inter-rater reliability. The largest of the 3 values for both hand span and hand length from the first assessor's first assessment were used to determine the normative between-hand difference. Outliers were removed prior to determining the normative difference. Children were considered outliers if their between-hand difference in hand span and/or hand length was in the top 5% of values.


      Excellent reliability was established for hand span and hand length measures for the whole group (intra-rater ICC2,1 ≥0.95, inter-rater ICC2,1 ≥0.94). The mean normative between-hand difference for both measures was 2 mm. The cut-off for the normative difference in hand span was <9 mm and hand length was <6 mm.


      This measurement technique has excellent reliability and could be a useful method to quantify palmar range of movement and identify contracture in young children with unilateral hand injuries.


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      JHT Read for Credit

      Quiz: # 856

      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.
        The authors’ primary goal was to establish a reliable clinical measurement technique for determining
        • a.
          palmar skin pliability in a pediatric population
        • b.
          the correlation between function and hand span
        • c.
          digital length vs palmar span
        • d.
          palmar ROM
      • # 2.
        Hand length was defined as the distance between the
        • a.
          confluence of the thenar and hypothenar eminences to the tip of the ring finger
        • b.
          distal pole of the scaphoid to the tip of the 3rd digit
        • c.
          1st wrist crease (radial aspect) to the tip of the 3rd finger
        • d.
          tip of the thumb to the tip of the little finger
      • # 3.
        The average difference between left and right hand span and length was approximately
        • a.
          2 mm
        • b.
          5 mm
        • c.
          1 cm
        • d.
          4 cm
      • # 4.
        Reliability was
        • a.
        • b.
        • c.
        • d.
          not measured
      • # 5.
        A key clinical application of the measure is to help recognize early contracture development
        • 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.