- •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.
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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- Acute hand burns in children: management and long-term outcome based on a 10-year experience with 698 injured hands.Ann Surg. 1999; 229: 558-564https://doi.org/10.1097/00000658-199904000-00016
- High prevalence of hand- and wrist-related symptoms, impairments, activity limitations and participation restrictions in children with juvenile idiopathic arthritis.J Rehabil Med. 2014; 46: 991-996https://doi.org/10.2340/16501977-1879
- Upper limb congenital muscular hypertrophy and aberrant muscle syndrome in children.J Hand Surg Eur Vol. 2018; 43: 751-755https://doi.org/10.1177/1753193418774459
- Impact of hand burns on health-related quality of life in children younger than 5 years.J Trauma Acute Care Surg. 2012; 73: S197-S204https://doi.org/10.1097/ta.0b013e318265c7ff
- Botulinum A chemodenervation: a new modality in cerebral palsied hands.Br J Plast Surg. 1993; 46: 703-706https://doi.org/10.1016/0007-1226(93)90203-N
- The role of two-sided splinting for recalcitrant pediatric post-burn hand flexion contracture: A case report.Ann R Coll Surg Engl. 2017; 99: e185-e187https://doi.org/10.1308/rcsann.2017.0103
- Upper extremity friction burns in the pediatric patient: A 10-year review.Plast Reconstr Surg - Glob Open. 2018; 6: 1-7https://doi.org/10.1097/GOX.0000000000002048
- Goniometry and linear assessments to monitor movement outcomes: Are they reliable tools in burn survivors?.Burns. 2009; 35: 58-62https://doi.org/10.1016/j.burns.2008.06.010
- Minimal detectable difference of the finger and wrist range of motion: comparison of goniometry and 3D motion analysis.J Orthop Surg Res. 2019; 14: 1-10https://doi.org/10.1186/s13018-019-1177-y
- Reliability of Thumb Web Measurements.J Hand Ther. 2004; 17: 58-63https://doi.org/10.1197/j.jht.2003.10.008
- The pollexograph: a new device for palmar abduction measurements of the thumb.J Hand Ther. 2009; 22: 271-277https://doi.org/10.1016/j.jht.2008.12.001
- The upper limb hypermobility assessment tool: a novel validated measure of adult joint mobility.Musculoskelet Sci Pract. 2018; 35: 38-45https://doi.org/10.1016/j.msksp.2018.02.006
- Treatment of palm burns in children.Ann Burns Fire Disasters. 2005; 18: 190-193
- Functional and cosmetic outcome of full- versus split-thickness skin grafts in pediatric palmar surface burns: A prospective, independent evaluation.J Burn Care Res. 2013; 34: 232-236https://doi.org/10.1097/BCR.0b013e31826fc53d
- Splinting strategies and controversies.J Burn Care Rehabil. 2005; 26: 392-396https://doi.org/10.1097/01.bcr.0000176886.63559.8b
- Outcomes of early and intensive use of a palm and digit extension orthosis in young children after burn injury.J Burn Care Res. 2020; 42: 245-257https://doi.org/10.1093/jbcr/iraa137
- Fundamentals of Pediatric Orthopedics.5th ed. Lippincott Williams & Wilkins, Philadelphia2016
- IBM SPSS Statistics (for Windows) [computer program].IBM Corp, Armonk, NY2019 (Version 26.0)
- Developing criteria for establishing inter-rater reliability of specific items. Applications to assessment of adaptive behavior.Am J Ment Defic. 1981; 86: 127-137
- A web-based sample size calculator for reliability studies.Educ Med J. 2018; 10: 67-76https://doi.org/10.21315/eimj2018.10.3.8
- Multimodal versus progressive treatment techniques to correct burn scar contractures.J Burn Care Rehabil. 2000; 21: 506-512https://doi.org/10.1097/00004630-200021060-00006
- A pilot prospective randomized control trial comparing exercises using videogame therapy to standard physical therapy: 6 Months follow-up.J Burn Care Res. 2015; 36: 534-544https://doi.org/10.1097/BCR.0000000000000165
- Hand preference, performance abilities, and hand selection in children.Front Psychol. 2014; 5: 1-15https://doi.org/10.3389/fpsyg.2014.00082
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 JHTReadforCredit.com. 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
- d.not measured
- # 5.A key clinical application of the measure is to help recognize early contracture development
When submitting to the HTCC for re-certification, please batch your JHT RFC certificates in groups of 3 or more to get full credit.
Published online: April 28, 2022
Accepted: March 10, 2022
Received in revised form: December 20, 2021
Received: July 26, 2021
Conflict of interest: All named authors hereby declare that they have no conflicts of interest to disclose.
© 2022 Elsevier Inc. All rights reserved.