Muscle Strength Measurements of the Hand

The hand has been called an extension of the brain, and the sensory and motor performance of the hand is based on adequate function of components in both the peripheral nerves as well as the central nervous systems. Damage to the nerves (e.g., injury, compression, infection [e.g. leprosy]) causes a loss of sensation and strength that may result in serious loss of hand function. According to Lundborg (2000) peripheral nerve lesions constitute one major reason for severe and longstanding impairment of hand function. He called the situation of nerve repair after injury frustrating because, although a nerve suture may be technically perfect and the rehabilitation carried out meticulously, the outcome is unpredictable and often disappointing. The evaluation of muscle strength is, in combination with the assessment of sensibility, an important clinical method to determine ulnar and median nerve function. This information is valuable in decision-making concerning surgery (e.g. tendon transfers), therapy (e.g. splints), advice in work-related issues (e.g. safety to work with machines) and research issues (e.g. nerve repair technique). Concerning this latter topic, Trumble et al. (1995) noted that without extremely sensitive methods for monitoring the functional outcome of nerve regeneration, it will be difficult to identify those factors that may have small but additive beneficial effects and those that may have negative effects on nerve regeneration. The main objective of the work presented in this thesis was to investigate the methods currently used to evaluate the motor domain of nerve function, i.e. manual muscle strength testing, and grip and pinch strength measurements. We questioned whether these methods give appropriate and sufficient information about the intrinsic muscle strength of the hand. Our hypothesis was that a dynamometer that provides quantitative data on the intrinsic muscle strength would provide more valuable information when monitoring the muscle strength of patients who have suffered nerve injuries of their arm

Decompression surgery for treating nerve damage in leprosy

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effects of decompression surgery for treating nerve damage in leprosy.<br/

Decompression surgery for treating nerve damage in leprosy

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:To assess the effects of decompression surgery for treating nerve damage in leprosy.<br/

Long-term outcome of muscle strength in ulnar and median nerve injury: Comparing manual muscle strength testing, grip and pinch strength dynamometers and a new intrinsic muscle strength dynamometer

Objective: To compare the outcome of muscle strength with manual muscle strength testing grip and pinch strength measurements and a dynamometer which allows for measurements of the intrinsic muscles of the hand in isolation (the Rotterdam Intrinsic Hand Myometer, RIHM). Methods: Thirty-four patients more than 2 years after ulnar and/or median nerve injury. Muscle strength was evaluated using manual muscle strength testing (MMST), grip, pinch and intrinsic muscle strength measurements. Results: Manual muscle strength testing showed that most muscles recover to grade 3 or 4. Average grip strength recovery, as percentage of the uninjured hand, was 83%. Pinch strength recovery was 75%, 58% and 39% in patients with ulnar, median and combined nerve injuries, respectively. The RIHM measurements revealed a poor recovery of the ulnar nerve innervated muscles in particular (26-37%). No significant correlation (Pearson) was found between the measurements of the RIHM and grip strength. Pinch strength was significantly correlated with strength of the abduction of thumb and opposition of the thumb strength (r 0.55 and 0.72, p = 0.026, 0.002) as measured with the RIHM. Conclusion: While manual muscle strength testing and grip strength measurements show a reasonable to good recovery, measurements of the intrinsic muscles by means of the RIHM showed poor recovery of intrinsic muscle strength after peripheral nerve injury. No correlation was found between the recovery of intrinsic muscle strength and grip strength measurements

Decompressive surgery for treating nerve damage in leprosy. A Cochrane review.

OBJECTIVE: Decompressive surgery is used for treating nerve damage in leprosy. We assessed the effectiveness of decompressive surgery for patients with nerve damage due to leprosy. METHODS: A broad search strategy was performed to find eligible studies, selecting randomised controlled trials (RCTs) comparing decompressive surgery alone or plus corticosteroids with corticosteroids alone, placebo or no treatment. Two authors independently assessed quality and extracted data. Where it was not possible to perform a meta-analysis, the data for each trial was summarised. RESULTS: We included two randomised controlled trials involving 88 people. The trials examined the added benefit of surgery over prednisolone for treatment of nerve damage of less than 6 months duration. After 2 years follow-up there was no significant difference in nerve function improvement between people treated with surgery plus prednisolone or with prednisolone alone. Adverse effects of decompression surgery were not adequately described. CONCLUSIONS: Evidence from randomised controlled trials does not show a significant added benefit of surgery over steroid treatment alone. Well-designed randomised controlled trials are needed to establish the effectiveness of the combination of surgery and medical treatment compared to medical treatment alone

High Median Nerve Paralysis:Is the Hand of Benediction or Preacher's Hand A Correct Sign?

High median nerve injuries are commonly presented in textbooks as adopting the typical posture of hand of benediction or preacher’s hand. This study aimed to show that the hand of benediction or preacher’s hand is incorrectly associated with a high median nerve paralysis. METHODS: A retrospective review of four cases with a high median nerve injury is presented. Diagnosis of a high median nerve injury was performed by means of intraoperative findings, electrodiagnostic studies, or ultrasound imaging. None of the patients presented in this study had a hand of benediction on physical examination despite the presence of a high median nerve lesion. RESULTS: All four patients with high median nerve injuries showed a similar hand posture when attempting to make a fist. Firstly, the index finger still flexed at the metacarpophalangeal joint because of the ulnar innervated interossei muscles. Secondly the thumb is completely abducted at the carpometocarpal joint and extended at the interphalangeal joint. Lastly, middle finger flexion is possible due to dual innervation of its flexor digitorum profundus by the ulnar nerve as well as due to the quadriga phenomenon. CONCLUSIONS: The clinical appearance of a high median nerve palsy is different from the classical hand of benediction or preacher’s hand posture pointing finger. We have shown that this incorrect association can result in delayed referral of patients with high median nerve injuries

Treatment and Management of Upper Extremity Dysfunction Following Transradial Percutaneous Coronary Intervention: A Prospective Cohort Study

Background: The transradial artery access is the benchmark approach in transradial percutaneous coronary intervention (TR-PCI). The purpose of this study was to evaluate the different complications, treatments, and outcome of upper extremity dysfunction following a TR-PCI. Methods: This was a prospective cohort substudy of patients with access-site complications. The study population consisted of 433 patients treated with TR-PCI. Referral to the hand center was mandated if the patient experienced new-onset or increase of preexistent symptoms in the upper extremity. Patients were followed up to the last control visit (5-7 months after the index procedure) at the hand center. Outcome results were categorized in “symptom-free,” “improvement of symptoms,” and “no improvement.” Results: Forty-one (9% of total) patients underwent assessment at the hand center. Most frequent referral indication was pain in the intervention arm. Women, preexisting sensibility disorder, and osteoarthritis in the intervention arm were associated with increased odds of referral. The most common complications diagnosed were carpal tunnel syndrome (n = 18) and osteoarthritis (n = 15). Thirty patients required further medical treatment. Immobilization therapy was most applied. Seventeen (4% of total) patients had persisting symptoms despite medical treatment. Conclusions: The occurrence of complications in the upper extremity after a TR-PCI is small. Despite medical treatment, symptoms persisted in 4% of all patients treated with TR-PCI. Possible explanations for the persisting symptoms are exacerbation of latent osteoarthritis and carpal tunnel syndrome by trauma-induced edema. Awareness of TR-PCI-induced complications among all specialists is essential to optimize patient care

Response to letter to the editor by videler et al.

We have read the valuable contribution of Videler et al. on signs of overwork weakness in patients with Charcot-Marie-Tooth (CMT). As in our study, overall, Videler et al. did not find a difference between the dominant and non-dominant hands in their CMT patients. This is in contrast with the study of Vinci et al., who, using manual muscle strength testing, found a stronger dominant hand in only 2 out of 212 muscles and a stronger non-dominant hand in 139 of these 212 muscles. When selecting only the more severely affected patients, Videler et al. did find in this group of 22 patients a small, but significantly stronger, non-dominant hand for the tripod pinch. We agree with Videler that the latter finding may fit with the hypothesis of overwork weakness. However, it should be noted that the difference in strength between both hands for the tripod pinch is relatively small and that the non-dominant hand is also severely weakened. Therefore, it is unclear if this difference is clinically relevant. As suggested by Videler et al., larger prospective cohort studies or interventions studies, preferably using more specific measures of intrinsic hand muscle function would be needed to conclude on the presence of overwork weakness.In summary, in the absence of a mechanism to explain overwork weakness in this population and in the absence of any data indicating that reducing activity would slow disease progression, we still feel that there is insufficient evidence to conclude that overwork weakness exists, and agree with Videler et al. that, at present, there are no grounds to advise patients to limit their activities

Response to letter to the editor by videler et al.

We have read the valuable contribution of Videler et al. on signs of overwork weakness in patients with Charcot-Marie-Tooth (CMT). As in our study, overall, Videler et al. did not find a difference between the dominant and non-dominant hands in their CMT patients. This is in contrast with the study of Vinci et al., who, using manual muscle strength testing, found a stronger dominant hand in only 2 out of 212 muscles and a stronger non-dominant hand in 139 of these 212 muscles. When selecting only the more severely affected patients, Videler et al. did find in this group of 22 patients a small, but significantly stronger, non-dominant hand for the tripod pinch. We agree with Videler that the latter finding may fit with the hypothesis of overwork weakness. However, it should be noted that the difference in strength between both hands for the tripod pinch is relatively small and that the non-dominant hand is also severely weakened. Therefore, it is unclear if this difference is clinically relevant. As suggested by Videler et al., larger prospective cohort studies or interventions studies, preferably using more specific measures of intrinsic hand muscle function would be needed to conclude on the presence of overwork weakness.In summary, in the absence of a mechanism to explain overwork weakness in this population and in the absence of any data indicating that reducing activity would slow disease progression, we still feel that there is insufficient evidence to conclude that overwork weakness exists, and agree with Videler et al. that, at present, there are no grounds to advise patients to limit their activities