Growth diagrams for individual finger strength in children measured with the RIHM

A detailed analysis of long-term outcomes following reconstruction for congenital thumb hypoplasia

This retrospective study analyses long-term outcomes of reconstruction for congenital thumb hypoplasia Grades 2 and 3 A. In 22 thumbs (mean follow-up 9 years), instability of the metacarpophalangeal joint was found in 20 thumbs regardless of the method of reconstruction, double breasting of local tissue with or without adductor pollicis advancement or use of a slip of flexor digitorum superficialis to supplement local tissue. There was a trend towards a greater global strength, higher Kapandji score and better subjective function score when the abductor digiti minimi was used as an opposition transfer as compared with the flexor digitorum superficialis. Results for motion and subjective parameters were consistent with comparable studies though these comparisons are compromised by different methods of classification and assessment. Consistent application of an expanded Blauth grading system and a formal hypoplastic thumb score will improve the ability to compare pre- and postoperative status, different techniques and results from different centres.Level of evidence: IV.

Measuring intrinsic hand strength in healthy adults: The accuracy intrarater and inter-rater reliability of the Rotterdam Intrinsic Hand Myometer

STUDY DESIGN

Clinical measurement study.

INTRODUCTION

Measuring the isometric strength generated during isolated hand joint motions is a challenging feat. The Rotterdam Intrinsic Hand Myometer (RIHM; med.engineers, Rotterdam, Netherlands) permits measurement of isolated movements of the hand. To date, there is limited evidence on the inter-rater reliability and limited adult normative data of RIHM. Given that multiple raters, often with varying degrees of experience, are needed to collect normative data, inter-rater reliability testing and a comparison of novice and experienced raters are needed.

PURPOSES OF THE STUDY

The purposes of this study were to test the accuracy, intrarater reliability, and inter-rater reliability of the RIHM in healthy-handed adults.

METHODS

RIHM accuracy was tested through use of precision class F weights. Adults 18 years or older without upper limb dysfunction were recruited. Each participant was tested by 4 raters, 3 occupational therapy graduate students, and an experienced certified hand therapist, through use of a calibrated RIHM. Five strength measures were tested bilaterally (ie, thumb carpometacarpal palmar abduction, index finger metacarpophalangeal [MP] abduction, index finger MP flexion, thumb MP flexion, and small finger MP abduction) 3 times per a standardized protocol. Statistical methods were used to test accuracy, inter-rater reliability, and intrarater/response stability.

RESULTS

The accuracy of RIHM device error was 5% or less. Reliability testing included the participation of 19 women and 10 men (n = 29). All raters were in excellent agreement across all muscles (intraclass correlation coefficient, ≥0.81). Low standard error of measurement values of ≤8.3 N (1.9 lb) across raters were found. The response stability and/or intrarater reliability of the novice and certified hand therapist raters were not statistically different.

DISCUSSION

The RIHM has an acceptable instrument error; the RIHM and its standardized procedure have excellent inter-rater reliability and response stability when testing those without hand limitations; and the response stability and/or intrarater reliability of expert and novice raters were consistent.

CONCLUSIONS

The use of the RIHM is justified when multiple raters of varying expertise collect normative data or conduct cohort studies on persons with healthy hands. Future research is warranted.

LEVEL OF EVIDENCE

Not applicable.

Reference values for muscle strength: a systematic review with a descriptive meta-analysis

BACKGROUND

Muscle strength is an important component of health.

OBJECTIVE

To describe and evaluate the studies which have established the reference values for muscle strength on healthy individuals and to synthesize these values with a descriptive meta-analysis approach.

METHODS

A systematic review was performed in MEDLINE, LILACS, and SciELO databases. Studies that investigated the reference values for muscle strength of two or more appendicular/axial muscle groups of health individuals were included. Methodological quality, including risk of bias was assessed by the QUADAS-2. Data extracted included: country of the study, sample size, population characteristics, equipment/method used, and muscle groups evaluated.

RESULTS

Of the 414 studies identified, 46 were included. Most of the studies had adequate methodological quality. Included studies evaluated: appendicular (80.4%) and axial (36.9%) muscles; adults (78.3%), elderly (58.7%), adolescents (43.5%), children (23.9%); isometric (91.3%) and isokinetic (17.4%) strength. Six studies (13%) with similar procedures were synthesized with meta-analysis. Generally, the coefficient of variation values that resulted from the meta-analysis ranged from 20.1% to 30% and were similar to those reported by the original studies. The meta-analysis synthesized the reference values of isometric strength of 14 muscle groups of the dominant/non-dominant sides of the upper/lower limbs of adults/elderly from developed countries, using dynamometers/myometer.

CONCLUSIONS

Most of the included studies had adequate methodological quality. The meta-analysis provided reference values for the isometric strength of 14 appendicular muscle groups of the dominant/non-dominant sides, measured with dynamometers/myometers, of men/women, of adults/elderly. These data may be used to interpret the results of the evaluations and establish appropriate treatment goals.

Reference values of intrinsic muscle strength of the hand of adolescents and young adults

STUDY DESIGN

A cross-sectional clinical measurement study.

INTRODUCTION

Measuring intrinsic hand muscle strength helps evaluate hand function or therapeutic outcomes. However, there are no established normative values in adolescents and young adults between 13 and 20 years of age.

PURPOSE OF THE STUDY

To measure hand intrinsic muscle strength and identify associated factors that may influence such in adolescents and young adults through use of the Rotterdam intrinsic hand myometer.

METHODS

A total of 131 participants (male: 63; female: 68) between 13 and 20 years of age completed the strength measurements of abductor pollicis brevis, first dorsal interosseus (FDI), deep head of FDI and lumbrical of second digit, flexor pollicis brevis (FPB), and abductor digiti minimi. Two trials of the measurements of each muscle were averaged for analyses. Self-reported demographic data were used to examine the influences of age, sex, and body mass index (BMI) on intrinsic hand muscle strength.

RESULTS

Normative values of intrinsic hand muscle strength were presented by age groups (13, 14, 15-16, 17-18, 19-20 year olds) for each sex category (male, female). A main effect of sex, but not age, on all the muscles on both the dominant (FPB: P = .02, others: P < .001) and non-dominant (FDI: P = .005, FPB: P = .01, others: P < .001) sides was found. A significant effect of BMI was found on dominant (P = .009) and non-dominant abductor pollicis brevis (P = .002). In addition, FDI (P = .005) and FPB (P = .002) were stronger on the dominant side than the non-dominant side.

DISCUSSION

Intrinsic hand muscle strength may be influenced by different factors including sex, BMI, and hand dominance. A larger sample is needed to rigorously investigate the influence of age on intrinsic strength in male and female adolescents and young adults.

CONCLUSION

The results provide reference values and suggest factors to be considered when evaluating hand function and therapeutic outcomes in both clinical and research settings. Further study is recommended.

LEVEL OF EVIDENCE

VI.

Outcome of flexor digitorum superficialis opponensplasty for Type II and IIIA thumb hypoplasia

This study reports on outcomes of the flexor digitorum superficialis tendon transfer from the ring finger in Type II and IIIA hypoplastic thumbs. We included 22 patients with 27 involved hands: 16 Type II thumbs and five Type IIIA treated by transfer and six non-operated Type II thumbs. The outcomes were assessed by range of motion, strength, sensibility, joint stability and patient/parent satisfaction. Compared with normative data, the range of motion was diminished in all patient groups. Opposition strength in operated Type II thumbs was significantly better than in non-operated thumbs. Grip strength, pinch strength, tripod strength and key pinch strength were approximately 50% of normal in Type II thumbs and 35% in Type IIIA thumbs. Metacarpophalangeal joint stability was restored in all operated Type II thumbs and in 40% of Type IIIA thumbs. We conclude that the flexor digitorum superficialis tendon transfer of the ring finger is a good functioning opponensplasty in both Type II and IIIA thumbs. The transfer provides excellent stability of the metacarpophalangeal joint in Type II thumbs.

LEVEL OF EVIDENCE

Level IV.

Stronger relation between impairment and manual capacity in the non-dominant hand than the dominant hand in congenital hand differences; implications for surgical and therapeutic interventions

OBJECTIVES

To evaluate manual activity capacity (i.e. activity capacity to perform hand activities) and its relation with body functions of the hand and forearm in children with congenital hand differences (CHD) METHODS: We assessed 10-14 year-old children with CHD (N = 106) using a functional handgrips test. Measurements of body functions included joint mobility and muscle strength. Patient characteristics were hand dominance and severity.

RESULTS

We found a stronger relation between body functions and manual activity capacity in non-dominant hands than dominant hands. Dominant hands scored significantly higher on manual activity capacity than nondominant hands that were similarly impaired at body functions level. Severity of the CHD and body functions had only small effects on manual activity capacity.

CONCLUSION

The relation between body functions and manual activity capacity is stronger in non-dominant hands than dominant hands, indicating that improvement in body functions lead to larger changes in manual activity capacity in the non-dominant hand. This may suggest that in bilaterally-affected children surgery should be done at the non-dominant hand first since this hand would benefit most from surgery-induced body functions improvement.

Relationships among manual body functions, manual capacity, and bimanual performance using the prosthetic upper extremity functional index in children with congenital hand differences

BACKGROUND

Most surgical techniques intervene at the level of body functions of the upper limb, aiming to improve manual capacity and activity performance. However, the nature of the relationships among these levels of functioning and evidence for hand function variables predicting performance have scarcely been investigated.

OBJECTIVE

The primary aim of this study was to assess aspects of hand function and manual capacity that influence bimanual performance in children with congenital hand differences (CHDs), ranging from surgically corrected polydactyly or syndactyly to radial dysplasia. A secondary aim was to assess whether the number of items on the Prosthetic Upper Extremity Functional Index (PUFI) can be reduced without losing information on bimanual performance in this population.

DESIGN

A cross-sectional design was used.

METHODS

One hundred six 10- to 14-year-old children with CHD participated in the study, which was conducted in a university hospital's outpatient clinic. Bimanual performance was evaluated with child self-reports on an adapted version of the PUFI, calculating ease of performance and actual use of the affected hand. Additionally, hand function and manual capacity were assessed.

RESULTS

The median score on ease of performance was high, and, on average, the children used their affected hand actively in 97% of all activities. Manual capacity of the nondominant hand and lateral pinch strength of the dominant hand predicted attainment of maximum PUFI scores. Nonmaximum PUFI scores were predicted by opposition strength of the nondominant hand and lateral pinch strength of the dominant hand. In addition, in this patient group, only 6 items of the PUFI explained all variance in PUFI scores.

LIMITATIONS

The generalizability of the results is limited by the carefully selected age range. Second, the cross-sectional design of the study limits statements on causality on the relationships found.

CONCLUSION

Children with a CHD generally have good bimanual performance and, on average, perform activities with active use of the affected hand. Therapy directed toward increasing manual capacity and finger muscle strength might assist in improving bimanual performance in children with CHD. Furthermore, the number of items on the PUFI could be reduced from 38 to 6 items in children with CHD.

Generalized joint hypermobility in healthy female koreans: prevalence and age-related differences

OBJECTIVE

Objective To evaluate the prevalence of generalized joint hypermobility (GJH) in healthy female Koreans and to determine whether the degree of GJH differs between children and adults.

METHODS

Two groups of females were enrolled, a group of girls from an elementary school (n=404) and women from a call center (n=266). GJH was diagnosed using the Beighton score, which is composed of an evaluation of bilateral knees, elbows, thumbs, and fifth fingers as well as thoracolumbar joint. The GJH and localized hypermobility of each joint was compared between the two groups, and the pattern of hypermobility according to age and dominant hand was investigated.

RESULTS

Total prevalence of GJH was 50.0% (335/750), and it was more frequently observed in the group of girls (58.9%, 238/404) than women (36.5%, 97/266). The degree of GJH expressed in terms of Beighton score was inversely correlated with age (p<0.05). Significant differences in localized hypermobility of the thumb and fifth finger were found between the two groups and were postulated as the cause for the decline in GJH with age. The pattern of decreased mobility proportional to aging differed between the two joints. Decreased mobility occurred equally on both sides of the thumb but was biased toward the fifth finger of the dominant side (mostly the right).

CONCLUSION

The female Koreans appeared to have a high prevalence of GJH. The incidence of GJH decreased as age increased as a result of decreased mobility of the fifth finger on the dominant side.