The objectives of my research are to improve the upper limb health and activity level of persons with acquired and congenital disabilities, to inform rehabilitation therapists and surgeons on best practice assessment and interventions for persons of these populations, and to establish the psychometric properties and reference values for assessments used to measure upper limb disability and health. Phone: 507-258-8016 Address: Programs in Occupational Therapy and Rehabilitation Science University of Minnesota MMC 368 420 Delaware Street Minneapolis, Minnesota 55455
Supplemental material, Supplemental Material3 for Reliability and precision of measuring strength... more Supplemental material, Supplemental Material3 for Reliability and precision of measuring strength of extrinsic muscles of the hand with the Rotterdam Intrinsic Hand Myometer by Corey McGee Leah Johnson, Julia Casper and Karleen Gregg in Journal of Hand Surgery (European Volume)
Supplemental material, Supplemental Material2 for Reliability and precision of measuring strength... more Supplemental material, Supplemental Material2 for Reliability and precision of measuring strength of extrinsic muscles of the hand with the Rotterdam Intrinsic Hand Myometer by Corey McGee Leah Johnson, Julia Casper and Karleen Gregg in Journal of Hand Surgery (European Volume)
Supplemental material, Supplemental Material1 for Reliability and precision of measuring strength... more Supplemental material, Supplemental Material1 for Reliability and precision of measuring strength of extrinsic muscles of the hand with the Rotterdam Intrinsic Hand Myometer by Corey McGee Leah Johnson, Julia Casper and Karleen Gregg in Journal of Hand Surgery (European Volume)
Research questions: 1) What are the age and gender stratified normative values of intrinsic hand ... more Research questions: 1) What are the age and gender stratified normative values of intrinsic hand strength in persons 50 years or older? 2) Do these stratified samples offer the precision to adequately estimate population means of each measure of intrinsic hand strength? 3) Within adults aged 50+, how do factors known to predict gross grasp strength predict measures of intrinsic hand strength? Rationale/Background: Intrinsic muscle function can be impacted by hand OA, peripheral nerve injuries, SCI, and ALS. However, intrinsic strength assessment is obscured by extrinsic strength during dynamometry. The Rotterdam Intrinsic Hand Myometer (RIHM) is a reliable and valid intrinsic strength testing device however, no adult normative data is yet available. Design: Descriptive normative design. Participants were recruited via convenience sampling at a state fair. Participants: Male and female adults 50 years or older without CNS conditions affecting upper limbs, rheumatological or cardiac conditions, deformity of tested digits, pain during testing, and inability to follow standardized procedures were included. Persons with hand osteoarthritis and musculoskeletal disorders were included. Methods to Obtain Data: 1) Health and demographic questionnaire 2) Myometry. Using standardized positions, four raters tested first dorsal interosseous (FDI), flexor pollicis brevis (FPB), abductor digiti minimi (ADM), interossei and lumbrical of the 2nd digit (FDI/Lum), and abductor pollicis brevis (APB) strength bilaterally. Analytical Methods (Sequentially according to research question): 1) Descriptive statistics, tests of skewness and kurtosis, and Shapiro-Wilk’s Test of Normality 2) Power Analysis 3) Backward stepwise mixed-effects linear modeling Results/Conclusion: 1) Data from 173 participants analyzed (63 males), 52 RIHM measures were normally distributed, and 8 were non-normally distributed. Mean strength greatest in FPB and least in ADM 2) Females (50-69) adequately powered (except dominant FPB). Males adequately powered for 50-59 NDomADM and 70-79 DomADM. Males approached adequate power for ADM and FDI muscles 3) Age, gender (male), and BMI*Gender(male) are significant predictors of strength. Thumb pain is a predictor for FDI strength. Non-significant predictors: hand/arm disorders, BMI (female), and handedness. Models explained 43-60% of variance in intrinsic strength Discussion: 1) Strength patterns likely due to size and function of the muscles. Intrinsic hand strength declines similarly in both genders 2) Inadequate power for measures of male strength likely due to reduced male volunteerism and higher normal variance in hand anthropometrics 3) Age and gender are significant predictors of intrinsic hand strength. BMI in males was a significant predictor of intrinsic strength. The absence of thumb pain was only a predictor for FDI strength. This supports belief that FDI weakness may correspond with thumb pain/CMC OA. Limitations: Twenty participants omitted weight from survey; thus a multiple imputations analysis was used for missing data. Convenience sampling resulted in an ethnically/racially homogenous sample. Future Research: 1) Continue recruiting males 2) Expand to include ages 20-49 yrs., more racial/ethnic diversity, and more aged 80+ 3) Expand normative data to include isolated measures of extrinsic muscles 4) Case-control studies using normative data as control and clinical populations as comparison groups (e.g., thumb CMC OA) Impact Statement: This is a first attempt at establishing strength norms for adult intrinsic hand muscles. These norms can be referenced to evaluate and plan OT interventions for intrinsic weakness. This data may also help to evaluate surgical success of tendon transfers for our clients with nerve palsies and SCI. Adult intrinsic hand strength norms are not yet reported. We report preliminary data from 5 intrinsic muscles bilaterally in 172 adults aged 50+ years. Upon completion, these norms can be used to evaluate and plan OT interventions for intrinsic weakness and help evaluate success of hand surgery.
Journal of Rehabilitation and Assistive Technologies Engineering, 2017
Measurement of the dynamic kinetics involved in opening a jar may enable health care professional... more Measurement of the dynamic kinetics involved in opening a jar may enable health care professionals to understand and train individuals in optimal hand/grip mechanics. This technical note details the design, validity, and reproducibility testing of a mimetic jar capable of measuring the forces and moments and isolated digital forces applied to the lid of the jar. An ecological jar instrument was designed with a torque limiter to provide a natural opening mechanism while a six-axis load cell and force sensing resistors recorded the way individuals applied force to the jar and lid during opening of a sealed container. A total of 115 volunteers participated in a validation of the device and an additional 36 participated in repeatability testing. Compared with prior instruments, this mimetic jar provides more force data and a simulated opening experience – making this jar instrument unique. Future studies utilizing the jar designed herein may allow health care professionals to evaluate p...
Date Presented 4/16/2015 Joint protection for hand osteoarthritis (OA) relies on theory but not e... more Date Presented 4/16/2015 Joint protection for hand osteoarthritis (OA) relies on theory but not empirical evidence. This study focuses on how hand positioning and nonskid materials influence forces, pain, and perceived effort during jar opening. New data challenge the belief that nonskid materials alone reduce hand forces.
Journal of hand therapy : official journal of the American Society of Hand Therapists, Jan 28, 2017
Clinical measurement study. Measuring the isometric strength generated during isolated hand joint... more Clinical measurement study. 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. The purposes of this study were to test the accuracy, intrarater reliability, and inter-rater reliability of the RIHM in healthy-handed adults. 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 ...
Journal of hand therapy : official journal of the American Society of Hand Therapists, Jan 11, 2017
A cross-sectional clinical measurement study. Measuring intrinsic hand muscle strength helps eval... more A cross-sectional clinical measurement study. 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. 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. 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. Normative values of intrinsic hand muscle strength were p...
OBJECTIVE. We evaluated whether a joint-protection strategy changes the mechanics of opening a se... more OBJECTIVE. We evaluated whether a joint-protection strategy changes the mechanics of opening a sealed jar. METHOD. Thirty-one adult women with hand osteoarthritis attempted to open a “sealed” jar instrument when using and not using nonskid material. Grip force, torque, success, and pain were recorded for each trial. RESULTS. Participants used less grip force when twisting with their left hand. The greatest torque and success, yet the least amount of grip force across time, and pain was noted when the left hand turned the lid, the jar was held vertically, the right hand supported the base, and nonskid material was used. CONCLUSION. Women with hand osteoarthritis should be educated to consider the hand they use and their approach when opening sealed jars. Use of nonskid material without additional reasoning may increase load on arthritic joints, pain, and dysfunction. Additional research on task kinematics and the kinetics of the stabilizing hand is needed.
Date Presented 4/19/2015 The literature indicates a void in the use of simulation during occupati... more Date Presented 4/19/2015 The literature indicates a void in the use of simulation during occupational therapy education. This study reveals that the addition of simulated learning in a high-acuity medical setting enhances student self-efficacy and preparedness for Level I fieldwork (FW) in medical contexts. Further study is required.
Dear Dr. MacDermid, Thank you for the opportunity to respond to the comments of evaluating surgeo... more Dear Dr. MacDermid, Thank you for the opportunity to respond to the comments of evaluating surgeon; an increase of 3/10,000th and 10/10,000th of a percentage point respectively.3 Dr. Villafañe and colleagues. We appreciate the interest in our work and the opportunity for dialogue. In their letter, Villafañe and colleagues raised the question of the safety of our study relative to radiation risks from the mini fluoroscopy unit and later go on to discuss their experiences with myofascial restrictions. We will first begin by responding to the topic of safety. At its inception, our study was reviewed and approved by an Institutional Review Board at a major University in the United States, which included reviews by the Human Research Protection Program and the Radiation Protection Division. The studywas given approval as ‘safe use of ionizing radiation for the human subjects’ by these expert panels. In that our research team provided convincing evidence that our research plan posed minimal risk to our volunteers and greater potential benefit than risk. We used numerous safety precautions including use of a mini C-Arm fluoroscopic device rather than a large c-arm device or conventional plain film x-rays. A mini C-arm device, evenwith direct exposure to the volunteers’/surgeon’s hand, produces only 1.42% of the exposure to radiation (w2.84 mRem/min)1 produced by a large fluoroscopic machine (200 mRem/min) even when a distance of 20 cm between the beam and surgeon is present.2 Furthermore, the risk to volunteers and the surgeons were also minimized with small exposure times. Volunteers were exposed to, at most, 3 s of radiation per evaluation and thus, even with 6 evaluations per participant, the direct total exposure to the hands of the volunteers and surgeonwould have been approximately .85mRem and 24.6mRem respectively. This exposure would respectively equate to .24% and 6.8% of the radiation one is naturally exposed to each year as a resident of the United States (360 mRem).3 Additionally, leaded aprons, thyroid shields, and leaded eye protectionwereworn by the surgeon throughout the entire testing period and thus, according to Mehlman and DiPasquale (1997)2 and Burns et al (2013),4 no measurable exposure would have been present in the neck or waist and eye exposure would have been reduced by 90%. Because there is an increased risk cancer-related death of .04% per lifetime exposure to 1000 mRem of radiation, after participating in the study, the normal lifetime risk of dying from cancer increased from 20% to 20.00034% for the volunteers and to 20.00098% for the
Supplemental material, Supplemental Material3 for Reliability and precision of measuring strength... more Supplemental material, Supplemental Material3 for Reliability and precision of measuring strength of extrinsic muscles of the hand with the Rotterdam Intrinsic Hand Myometer by Corey McGee Leah Johnson, Julia Casper and Karleen Gregg in Journal of Hand Surgery (European Volume)
Supplemental material, Supplemental Material2 for Reliability and precision of measuring strength... more Supplemental material, Supplemental Material2 for Reliability and precision of measuring strength of extrinsic muscles of the hand with the Rotterdam Intrinsic Hand Myometer by Corey McGee Leah Johnson, Julia Casper and Karleen Gregg in Journal of Hand Surgery (European Volume)
Supplemental material, Supplemental Material1 for Reliability and precision of measuring strength... more Supplemental material, Supplemental Material1 for Reliability and precision of measuring strength of extrinsic muscles of the hand with the Rotterdam Intrinsic Hand Myometer by Corey McGee Leah Johnson, Julia Casper and Karleen Gregg in Journal of Hand Surgery (European Volume)
Research questions: 1) What are the age and gender stratified normative values of intrinsic hand ... more Research questions: 1) What are the age and gender stratified normative values of intrinsic hand strength in persons 50 years or older? 2) Do these stratified samples offer the precision to adequately estimate population means of each measure of intrinsic hand strength? 3) Within adults aged 50+, how do factors known to predict gross grasp strength predict measures of intrinsic hand strength? Rationale/Background: Intrinsic muscle function can be impacted by hand OA, peripheral nerve injuries, SCI, and ALS. However, intrinsic strength assessment is obscured by extrinsic strength during dynamometry. The Rotterdam Intrinsic Hand Myometer (RIHM) is a reliable and valid intrinsic strength testing device however, no adult normative data is yet available. Design: Descriptive normative design. Participants were recruited via convenience sampling at a state fair. Participants: Male and female adults 50 years or older without CNS conditions affecting upper limbs, rheumatological or cardiac conditions, deformity of tested digits, pain during testing, and inability to follow standardized procedures were included. Persons with hand osteoarthritis and musculoskeletal disorders were included. Methods to Obtain Data: 1) Health and demographic questionnaire 2) Myometry. Using standardized positions, four raters tested first dorsal interosseous (FDI), flexor pollicis brevis (FPB), abductor digiti minimi (ADM), interossei and lumbrical of the 2nd digit (FDI/Lum), and abductor pollicis brevis (APB) strength bilaterally. Analytical Methods (Sequentially according to research question): 1) Descriptive statistics, tests of skewness and kurtosis, and Shapiro-Wilk’s Test of Normality 2) Power Analysis 3) Backward stepwise mixed-effects linear modeling Results/Conclusion: 1) Data from 173 participants analyzed (63 males), 52 RIHM measures were normally distributed, and 8 were non-normally distributed. Mean strength greatest in FPB and least in ADM 2) Females (50-69) adequately powered (except dominant FPB). Males adequately powered for 50-59 NDomADM and 70-79 DomADM. Males approached adequate power for ADM and FDI muscles 3) Age, gender (male), and BMI*Gender(male) are significant predictors of strength. Thumb pain is a predictor for FDI strength. Non-significant predictors: hand/arm disorders, BMI (female), and handedness. Models explained 43-60% of variance in intrinsic strength Discussion: 1) Strength patterns likely due to size and function of the muscles. Intrinsic hand strength declines similarly in both genders 2) Inadequate power for measures of male strength likely due to reduced male volunteerism and higher normal variance in hand anthropometrics 3) Age and gender are significant predictors of intrinsic hand strength. BMI in males was a significant predictor of intrinsic strength. The absence of thumb pain was only a predictor for FDI strength. This supports belief that FDI weakness may correspond with thumb pain/CMC OA. Limitations: Twenty participants omitted weight from survey; thus a multiple imputations analysis was used for missing data. Convenience sampling resulted in an ethnically/racially homogenous sample. Future Research: 1) Continue recruiting males 2) Expand to include ages 20-49 yrs., more racial/ethnic diversity, and more aged 80+ 3) Expand normative data to include isolated measures of extrinsic muscles 4) Case-control studies using normative data as control and clinical populations as comparison groups (e.g., thumb CMC OA) Impact Statement: This is a first attempt at establishing strength norms for adult intrinsic hand muscles. These norms can be referenced to evaluate and plan OT interventions for intrinsic weakness. This data may also help to evaluate surgical success of tendon transfers for our clients with nerve palsies and SCI. Adult intrinsic hand strength norms are not yet reported. We report preliminary data from 5 intrinsic muscles bilaterally in 172 adults aged 50+ years. Upon completion, these norms can be used to evaluate and plan OT interventions for intrinsic weakness and help evaluate success of hand surgery.
Journal of Rehabilitation and Assistive Technologies Engineering, 2017
Measurement of the dynamic kinetics involved in opening a jar may enable health care professional... more Measurement of the dynamic kinetics involved in opening a jar may enable health care professionals to understand and train individuals in optimal hand/grip mechanics. This technical note details the design, validity, and reproducibility testing of a mimetic jar capable of measuring the forces and moments and isolated digital forces applied to the lid of the jar. An ecological jar instrument was designed with a torque limiter to provide a natural opening mechanism while a six-axis load cell and force sensing resistors recorded the way individuals applied force to the jar and lid during opening of a sealed container. A total of 115 volunteers participated in a validation of the device and an additional 36 participated in repeatability testing. Compared with prior instruments, this mimetic jar provides more force data and a simulated opening experience – making this jar instrument unique. Future studies utilizing the jar designed herein may allow health care professionals to evaluate p...
Date Presented 4/16/2015 Joint protection for hand osteoarthritis (OA) relies on theory but not e... more Date Presented 4/16/2015 Joint protection for hand osteoarthritis (OA) relies on theory but not empirical evidence. This study focuses on how hand positioning and nonskid materials influence forces, pain, and perceived effort during jar opening. New data challenge the belief that nonskid materials alone reduce hand forces.
Journal of hand therapy : official journal of the American Society of Hand Therapists, Jan 28, 2017
Clinical measurement study. Measuring the isometric strength generated during isolated hand joint... more Clinical measurement study. 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. The purposes of this study were to test the accuracy, intrarater reliability, and inter-rater reliability of the RIHM in healthy-handed adults. 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 ...
Journal of hand therapy : official journal of the American Society of Hand Therapists, Jan 11, 2017
A cross-sectional clinical measurement study. Measuring intrinsic hand muscle strength helps eval... more A cross-sectional clinical measurement study. 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. 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. 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. Normative values of intrinsic hand muscle strength were p...
OBJECTIVE. We evaluated whether a joint-protection strategy changes the mechanics of opening a se... more OBJECTIVE. We evaluated whether a joint-protection strategy changes the mechanics of opening a sealed jar. METHOD. Thirty-one adult women with hand osteoarthritis attempted to open a “sealed” jar instrument when using and not using nonskid material. Grip force, torque, success, and pain were recorded for each trial. RESULTS. Participants used less grip force when twisting with their left hand. The greatest torque and success, yet the least amount of grip force across time, and pain was noted when the left hand turned the lid, the jar was held vertically, the right hand supported the base, and nonskid material was used. CONCLUSION. Women with hand osteoarthritis should be educated to consider the hand they use and their approach when opening sealed jars. Use of nonskid material without additional reasoning may increase load on arthritic joints, pain, and dysfunction. Additional research on task kinematics and the kinetics of the stabilizing hand is needed.
Date Presented 4/19/2015 The literature indicates a void in the use of simulation during occupati... more Date Presented 4/19/2015 The literature indicates a void in the use of simulation during occupational therapy education. This study reveals that the addition of simulated learning in a high-acuity medical setting enhances student self-efficacy and preparedness for Level I fieldwork (FW) in medical contexts. Further study is required.
Dear Dr. MacDermid, Thank you for the opportunity to respond to the comments of evaluating surgeo... more Dear Dr. MacDermid, Thank you for the opportunity to respond to the comments of evaluating surgeon; an increase of 3/10,000th and 10/10,000th of a percentage point respectively.3 Dr. Villafañe and colleagues. We appreciate the interest in our work and the opportunity for dialogue. In their letter, Villafañe and colleagues raised the question of the safety of our study relative to radiation risks from the mini fluoroscopy unit and later go on to discuss their experiences with myofascial restrictions. We will first begin by responding to the topic of safety. At its inception, our study was reviewed and approved by an Institutional Review Board at a major University in the United States, which included reviews by the Human Research Protection Program and the Radiation Protection Division. The studywas given approval as ‘safe use of ionizing radiation for the human subjects’ by these expert panels. In that our research team provided convincing evidence that our research plan posed minimal risk to our volunteers and greater potential benefit than risk. We used numerous safety precautions including use of a mini C-Arm fluoroscopic device rather than a large c-arm device or conventional plain film x-rays. A mini C-arm device, evenwith direct exposure to the volunteers’/surgeon’s hand, produces only 1.42% of the exposure to radiation (w2.84 mRem/min)1 produced by a large fluoroscopic machine (200 mRem/min) even when a distance of 20 cm between the beam and surgeon is present.2 Furthermore, the risk to volunteers and the surgeons were also minimized with small exposure times. Volunteers were exposed to, at most, 3 s of radiation per evaluation and thus, even with 6 evaluations per participant, the direct total exposure to the hands of the volunteers and surgeonwould have been approximately .85mRem and 24.6mRem respectively. This exposure would respectively equate to .24% and 6.8% of the radiation one is naturally exposed to each year as a resident of the United States (360 mRem).3 Additionally, leaded aprons, thyroid shields, and leaded eye protectionwereworn by the surgeon throughout the entire testing period and thus, according to Mehlman and DiPasquale (1997)2 and Burns et al (2013),4 no measurable exposure would have been present in the neck or waist and eye exposure would have been reduced by 90%. Because there is an increased risk cancer-related death of .04% per lifetime exposure to 1000 mRem of radiation, after participating in the study, the normal lifetime risk of dying from cancer increased from 20% to 20.00034% for the volunteers and to 20.00098% for the
McGee, C. W. (2014). Preventing and treating stiffness. Cooper C. Fundamentals of Hand Therapy: C... more McGee, C. W. (2014). Preventing and treating stiffness. Cooper C. Fundamentals of Hand Therapy: Clinical Reasoning and Treatment Guidelines for Common Diagnoses of the Upper Extremity. 2ª ed. St Louis: Elsevier Health Sciences, 524-41.
Purposes: Joint protection strategies are often recommended for individuals with hand arthritis. ... more Purposes: Joint protection strategies are often recommended for individuals with hand arthritis. However, there is little research regarding their effectiveness or on the use of measures in evaluating the effects of joint protection strategies. The purposes of this study were to 1) evaluate the effects of the type of grasp, the hand grasping the lid, and the use of non-skid material on the hand forces acting upon a jar lid when breaking a jar's seal, 2) examine the hand forces requirements when opening a sealed jar and 3) investigate relationships between several measures of hand function and the actual hand forces used during the everyday task of opening a sealed jar in order to validate their use in measuring the effectiveness of joint protection strategies such as using a counterforce such as a table or opposing extremity and using a nonskid material.Methods: A novel jar device created by McGee, Nuckley, and Mathiowetz was used to gather measurements of grip force, compressive force down through the lid's axis of rotation (Fz) and compressive force perpendicular to the side of the lid (Fx/Fy) when attempting to open a `sealed jar'. The jar lid's torque requirement was set to 4.24 N*m, a torque commonly imposed by the manufacturer when creating a seal on larger diameter jars. Thirty-one women with hand osteoarthritis were asked to complete 16 jar opening simulations by alternating three different factors: hand turning the jar lid, position (supinated/vertical and oblique/diagonal), and use of a non-skid material. After each jar turning simulation, participants were asked to report their perceived level of pain and exertion using the 0 to 10 scales of the NRS and Borg CR10, respectively. Additional measures of hand function were quantified to determine if and to what extent they predicted success and the capacity to generate forces when opening a sealed jar.Results: The impact of arthritis on our sample's function was modest (AIMS2-SF2 Total Health Score; x = 10.62) and the distribution of arthritis between hands was not dissimilar. Use of the supinated grasp required less force/time in Fx [F(1,419)=30.5, p<.0001], Fy [F(1,419)=34.5, p<.0001], and Fz than power grasp [F(1,419)=23.5, p<.0001]. Participants used less grip force to twist the lid with their left hand than with their right hand [F(1,419)=21.7, p<.0001]. Participants also perceived their effort to be less when using their left hand, a supinated grasp, and non-skid material. Additionally, participants rated their pain as lower when using their left hand and when using a supinated grasp. Lastly, a left supinated grasp with a non-skid material was a significantly more successful strategy to open jars than was any other (χ2=9.4, p<.001). Across all approaches, participants who were successful used 149.2±6.2 N of grip force and 47.8±2.8 N of `compensatory' forces when opening the sealed jar. Perceived effort was a significant positive predictor of grip force across time and is a significant negative predictor of peak M(z). Palmar abduction of the stabilizing thumb was a significant positive predictor of torque and a negative predictor of grip forces. Total active motion of the stabilizing and turning thumbs was a positive predictor of grip force and an increase in pain from baseline was a significant negative predictor of grip force and a positive predictor of torque.Conclusions: The counterforce offered by the supinated `stabilizing' hand results in the use of fewer compensatory forces by the turning hand. The left hand requires less grip force to successfully open a sealed jar and pain as well as perceived effort were least among those who used a non-skid material when opening. This data supports that women with hand arthritis will know more success, perceive less pain and effort, use less grip force, and will more efficiently generate the forces required to break the seal of a large jar when using a left hand, supinated counterforce, and non-skid material. These findings validate the use of non-skid material to reduce hand forces with jar turning but only when combined with a supinated approach. Perceived effort, and a change in pain from baseline are strong predictors of the forces used during jar opening and thus should be considered when considering the effectiveness of joint protection strategies used by women with hand osteoarthritis when attempting to open sealed jars. Other measures of hand function were also predictive of the hand forces generated when opening a sealed jar and these factors should be considered during assessment and intervention planning.
Reviewed this article for the "Year Book of Hand and Upper Limb Surgery, 2015"
Context: Upper qu... more Reviewed this article for the "Year Book of Hand and Upper Limb Surgery, 2015"
Context: Upper quarter injuries have a higher incidence in female swimmers; however, to date, there are few ways to assess the basic functional ability of this region. The upper quarter Y balance test (YBT-UQ) may assist in this process because it was developed to provide a fundamental assessment of dynamic upper quarter ability at the limit of stability. Objective: To examine how sex affects performance on the YBT-UQ in swimmers. Design: Cohort study. Patients or Other Participants: Forty-three male and 54 female National Collegiate Athletic Association Division I college swimmers were recruited preseason. Main Outcome Measure(s): We measured YBT-UQ performance for the left and right limbs in the medial, inferolateral, and superolateral directions. The maximum score for each direction was normalized to upper extremity length. The average of the greatest normalized reach scores in each reach direction was used to develop a composite score (average distance in 3 directions/limb length [LL] x 100). To examine reach symmetry between sexes, the difference in centimeters between the left and right sides was calculated for each reach direction prior to normalization. Statistical analysis was conducted using an independent-samples f test (P Results: Average scores in the medial (women: 92.5 [+ or -] 7.4%LL, men: 100.0 [+ or -] 8.7%LL; P Conclusions: Performance on several YBT-UQ indices was worse for female than male collegiate swimmers. These results may have implications for the use of preseason and return-to-sport testing in swimmers as a measurement of upper quarter function and symmetry. Key Words: Y-Balance test, core stability, shoulder function, injury risk
Butler, Robert, et al. "Sex differences in dynamic closed kinetic chain upper quarter function in collegiate swimmers." Journal of Athletic Training 49.4 (2014): 442+. Academic OneFile. Web. 2 Aug. 2016.
Reviewed this Article for the "Year Book of Hand and Upper Limb Surgery, 2015"
Objectives
To com... more Reviewed this Article for the "Year Book of Hand and Upper Limb Surgery, 2015"
Objectives To compare sternoclavicular, acromioclavicular, and scapulothoracic joint motion between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation.
Background Differences in scapulothoracic kinematics are associated with shoulder pain. Several studies have measured these differences using surface sensors, but the results of this technique may be affected by skin-motion artifact. Furthermore, previous studies have not included the simultaneous measurement of sternoclavicular and acromioclavicular joint motion.
Methods Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals for direct, bone-fixed tracking using electromagnetic sensors. Angular positions for the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder flexion, abduction, and scapular plane abduction.
Results Differences between groups were found for sternoclavicular and scapulothoracic joint positions. Symptomatic individuals consistently demonstrated less sternoclavicular posterior rotation, regardless of angle, phase, or plane of shoulder motion. Symptomatic individuals also demonstrated less scapulothoracic upward rotation at 30° and 60° of humerothoracic elevation during shoulder abduction and scapular plane abduction.
Conclusion The results of this study show that differences in shoulder complex kinematics exist between symptomatic and asymptomatic individuals. However, the magnitude of these differences was small, and the resulting clinical implications are not yet fully understood. The biomechanical coupling of the sternoclavicular and acromioclavicular joints requires further research to better understand scapulothoracic movement deviations and to improve manual therapy and exercise-based physical therapy interventions. J Orthop Sports Phys Ther 2014;44(9):636–645. Epub 7 August 2014. doi:10.2519/jospt.2014.5339
Contributing reviewer of the this paper in the "Year Book of Hand and Upper Limb Surgery, 2015"
... more Contributing reviewer of the this paper in the "Year Book of Hand and Upper Limb Surgery, 2015"
BACKGROUND: There is limited Level-I evidence that compares operative and nonoperative treatment of rotator cuff tears. We compared outcomes of patients treated with primary tendon repair with outcomes of those treated with physiotherapy and optional secondary tendon repair if needed.
METHODS: A single-center, pragmatic, randomized controlled study with follow-ups after six months and one, two, and five years was conducted in a secondary-care institution. One hundred and three patients with a rotator cuff tear not exceeding 3 cm were randomized to primary tendon repair (n = 52) or physiotherapy (n = 51). The primary outcome measure was the Constant score. Secondary outcome measures included the self-report section of the American Shoulder and Elbow Surgeons score; the physical component summary measure of the Short Form 36 Health Survey; the measurement of pain, strength, and shoulder motion; patient satisfaction; and findings from magnetic resonance imaging and sonography. Analysis was by intention to treat.
RESULTS: The five-year follow-up rate was 98%. Twelve of the fifty-one patients in the physiotherapy group were treated with secondary tendon repair. The results from primary tendon repair were superior to those from physiotherapy plus secondary repair, with between-group mean differences of 5.3 points on the Constant score (p = 0.05), 9.0 points on the American Shoulder and Elbow Surgeons score (p < 0.001), 1.1 cm on a 10-cm visual analog scale for pain (p < 0.001), and 1.0 cm on a 10-cm visual analog scale for patient satisfaction (p = 0.03). In 37% of tears treated with physiotherapy only, there were increasing tear sizes on ultrasound of >5 mm, over five years, associated with an inferior outcome.
CONCLUSIONS: Although primary repair of small and medium-sized rotator cuff tears was associated with better outcome than physiotherapy treatment, the differences were small and may be below clinical importance. In the physiotherapy treatment group, there were increasing tear sizes and inferior outcomes in one-third of patients who did not undergo repair.
Contributing reviewer of the this paper in the "Year Book of Hand and Upper Limb Surgery, 2015"
... more Contributing reviewer of the this paper in the "Year Book of Hand and Upper Limb Surgery, 2015"
This article provides video and narration to describe the technical details of how to inject local anesthesia and perform the extensor indicis proprius to extensor pollicis longus tendon transfer in patients with wide-awake local anesthesia and no tourniquet. Lidocaine for anesthesia and epinephrine for hemostasis are the only 2 medications given to the patient. Sedation and the tourniquet are not required. Wide-awake patients are comfortable, cooperative, and educable, and are able to help the surgeon set the correct tension for the transfer. They flex and extend the thumb before the skin is closed to make sure the transfer is not too tight or too loose. It helps that they remember seeing the thumb move nicely during the surgery when they are in postoperative hand therapy.
BODY: Results: The sample had a symmetrical distribution of hand OA (ns) (Table 1). Participants ... more BODY: Results: The sample had a symmetrical distribution of hand OA (ns) (Table 1). Participants used less hand force when twisting with their left hand (p<.0001). The smallest hand force across time was produced by the left nonskid supinated approach (p<.05). Conversely, the highest average torque was used during the left nonskid supinated approach (p<.05) (Figure 2a). The left hand had significantly lower pain ratings than the right hand (p=.05) after turning. For both hands, participants rated significantly less pain when using a supinated grasp pattern (p<.0001). Participants rated PE significantly lower when using the left hand to turn (p<.0001), the supinated grasp pattern (p<.0001), and nonskid material (p<.0001) (Figure 2b). A left supinated grasp with a nonskid material was a significantly more successful strategy to open jars than was any other (χ 2 =9.4, p<.001). Conclusion: The data supports that women with hand OA will know more success, report less pain and effort, use less hand force, and will more effectively produce torques when twisting lids with the left hand, grasping the base of the jar with a supinated right hand, and using nonskid material. Nonskid material, when used by the right hand during opening, does not have the same hand force and pain reducing effects. This data challenges the belief that nonskid materials alone reduce hand forces. Hand therapists should consider how the stabilizing hand supports the jar and which hand grasps the lid when recommending use of nonskid materials for opening sealed jars. The use of nonskid material without additional reasoning will likely increase loads on arthritic joints, pain and, dysfunction. Given the composition of the sample, these findings are most generalizable to a symptomatic population of women with bilateral thumb CMC OA. Purpose: To investigate if hand force profiles, pain, and perceived effort of women with hand osteoarthritis differ by a) the hand twisting the lid, b) grasp pattern of the stabilizing hand, and c) the use of a nonskid material when attempting to open a sealed jar. Methods: Women (n=31), aged18 years+, were recruited through orthopedic, women's health, and hand therapy clinics, as well as community-based centers serving older adults. Participants were eligible if they were female, aged 18 years+, and had radiographicially confirmed and symptomatic hand osteoarthritis (OA). A 2x2x2 experimental cross-sectional design was used to study within-subject differences in pain, perceived effort (PE), hand force profiles, hand forces across time, and hand generated torques during a jar-opening task across three factors: 1) orientation of hand used to stabilize the jar's base (supinated vs. oblique), 2) hand used to twist the lid (right vs. left), and 3) use of nonskid material when twisting the lid (yes vs. no). (Figure 1a) An ecologically valid jar device
INTRODUCTION. Hypermobility of the carpometacarpal (CMC) joint is a major etiological factor in t... more INTRODUCTION. Hypermobility of the carpometacarpal (CMC) joint is a major etiological factor in the development of thumb arthritis. Stabilization of the CMC joint with reduction of joint subluxation theoretically reduces the risk of arthritis. The hypothesis of this study is that activation of the first dorsal interosseous (FDI) muscle will reduce CMC subluxation of the metacarpal as measured by fluoroscopy.
METHODS. Subjects at least 18 years old were recruited. Exclusion criteria included a history of hand arthritis, positive grind test, pregnancy, and major conditions of ligamentous laxity. A certified hand therapist performed a grind test, measured grip and pinch strength, and maximal voluntary contraction of the FDI using the Rotterdam Intrinsic Hand Myometer. Fluoroscopy was used to obtain true AP radiographs of the CMC joint at 1) rest, 2) while stressed without activation of the FDI and 3) while stressed with activation of the FDI. Radial subluxation of the first metacarpal and metacarpal width were measured by 3 blinded surgeons as described by Wolf (2011). RESULTS. Seventeen subjects with 34 thumbs (5 male and 12 female) participated. Average age was 25.9(21-59). Thirteen right handed, one left handed, and 3 ambidextrous subjects were included. Two thumbs were excluded for a positive grind. Thirty-two thumbs were evaluated. Average maximal voluntary contraction of the FDI was 27N, lateral pinch 81N, and grip strength 347N. Twenty-seven thumbs demonstrated subluxation when stressed with reduction after activation of the FDI. Three thumbs were not subluxed at rest and did not sublux with stress or reduce with firing of the FDI, consistent with stiff CMC joints. Two thumbs were subluxed at rest but did not further sublux with stress. Inter-rater reliability of this categorization was high(ICC>.74). In the 27 thumbs that demonstrated increased subluxation with stress, subluxation while stressed averaged 0.6 cm(0.0- 0.9) or 48%(29-75) of articular width. FDI activation reduced subluxation by an average of 0.5 cm(0.1-0.9) or 80%(20- 120). The two thumbs with the same degree of subluxation at rest and with stress had subluxation of 0.5 cm and 0.7 cm corresponding to 43% and 63% of articular width, respectively. Reduction with FDI activation was by 0.3 cm and 0.2 cm or 67% and 28%, respectively. When the CMC joint was stressed and FDI activated, maximum FDI strength explained 32.3% of the variability in subluxation.
DISCUSSION. The FDI radiographically reduces subluxation of the thumb CMC joint. Strengthening the FDI may be an effective intervention in preventing arthritis.
Introduction: Hypermobility of the carpometacarpal (CMC) joint is a major etiological factor in t... more Introduction: Hypermobility of the carpometacarpal (CMC) joint is a major etiological factor in the development of thumb arthritis. Stabilization of the CMC joint with reduction of joint subluxation theoretically reduces the risk of arthritis. The hypothesis of this study is that activation of the first dorsal interosseous (FDI) muscle will reduce CMC subluxation of the metacarpal as measured by fluoroscopy.
Methods: Subjects at least 18 years old were recruited. Exclusion criteria included a history of hand arthritis, positive grind test, pregnancy, and major conditions of ligamentous laxity. A certified hand therapist performed a grind test, measured grip and pinch strength, and maximal voluntary contraction of the FDI using the Rotterdam Intrinsic Hand Myometer. Fluoroscopy was used to obtain true AP radiographs of the CMC joint at 1) rest, 2) while stressed without activation of the FDI and 3) while stressed with activation of the FDI. Radial subluxation of the first metacarpal and metacarpal width were measured by 3 blinded surgeons as described by Wolf (2011).
Results: Seventeen subjects with 34 thumbs (5 male and 12 female) participated. Average age was 25.9(21-59). Thirteen right handed, one left handed, and 3 ambidextrous subjects were included. Two thumbs were excluded for a positive grind. Thirty-two thumbs were evaluated. Average maximal voluntary contraction of the FDI was 27N, lateral pinch 81N, and grip strength 347N. Twenty-seven thumbs demonstrated subluxation when stressed with reduction after activation of the FDI. Three thumbs were not subluxed at rest and did not sublux with stress or reduce with firing of the FDI, consistent with stiff CMC joints. Two thumbs were subluxed at rest but did not further sublux with stress. Inter-rater reliability of this categorization was high(ICC>.74). In the 27 thumbs that demonstrated increased subluxation with stress, subluxation while stressed averaged 0.6 cm(0.0-0.9) or 48%(29-75) of articular width. FDI activation reduced subluxation by an average of 0.5 cm(0.1-0.9) or 80%(20-120). The two thumbs with the same degree of subluxation at rest and with stress had subluxation of 0.5 cm and 0.7 cm corresponding to 43% and 63% of articular width, respectively. Reduction with FDI activation was by 0.3 cm and 0.2 cm or 67% and 28%, respectively. When the CMC joint was stressed and FDI activated, maximum FDI strength explained 32.3% of the variability in subluxation.
Conclusion: The FDI radiographically reduces subluxation of the thumb CMC joint. Strengthening the FDI may be an effective intervention in preventing arthritis.
INTRODUCTION: Hypermobility of the carpometacarpal (CMC) joint is a well described etiological fa... more INTRODUCTION: Hypermobility of the carpometacarpal (CMC) joint is a well described etiological factor in the development of thumb arthritis. Hypermobility leads to joint subluxation and osteoarthritis secondary to resultant joint incongruity. We hypothesize that activation of the First Dorsal Interosseous (FDI) muscle will radiographically reduce subluxation of the 1st metacarpal relative to the trapezium.
METHODS: Subjects at least 18 years old were recruited. Exclusion criteria included positive grind test, pregnancy, and major conditions of ligamentous laxity. A certified hand therapist performed a grind test on all subjects. Using a hand-held manometer, maximal voluntary contraction of the FDI as measured by the Rotterdam Intrinsic Myometer; lateral pinch strength, and grip strength were measured. Fluoroscopy was used to obtain true AP radiographs of the CMC joint at (1) rest, (2) while stressed without activation of the FDI, and (3) while stressed with activation of the FDI. Radial subluxation of the base of the first metacarpal and metacarpal width were measured by 3 blinded surgeons as described by Wolf (2011). The ratio of radial subluxation to the articular width was calculated.
RESULTS: Seventeen subjects with 34 thumbs including 5 males and 12 females participated. Average age was 25.9 (21-59). Thirteen right-handed, 1 left-handed, and 3 ambidextrous subjects were included. Two thumbs were excluded for a positive grind and one for poor radiograph quality. Thirty-one thumbs were evaluated. Average maximal voluntary contraction of the FDI was 27N, lateral pinch 81N, and grip strength 347N. Twenty-six thumbs demonstrated subluxation when stressed and reduction after firing of the FDI. Three thumbs were not subluxed at rest and did not sublux with stress, consistent with stiff CMC joints. Two thumbs were subluxed at rest but did not further sublux with stress. Inter-rater reliability was high (96%). In the 26 thumbs that demonstrated increased subluxation with stress, subluxation while stressed averaged 48% (29-75) of metacarpal articular width. FDI activation reduced subluxation by an average of 80% (20-120). The two thumbs with the same degree of subluxation at rest and with stress had subluxation 43% and 63% of articular width. Reduction with FDI activation was 67% and 28%, respectively.
CONCLUSION: The FDI radiographically reduces subluxation of the thumb CMC joint.Strengthening the FDI may be effective in preventing thumb arthritis.
Introduction: Hypermobility of the carpometacarpal (CMC) joint is a major etiological factor in t... more Introduction: Hypermobility of the carpometacarpal (CMC) joint is a major etiological factor in the development of thumb arthritis. Stabilization of the CMC joint with reduction of joint subluxation theoretically reduces the risk of arthritis. The hypothesis of this study is that activation of the first dorsal interosseous (FDI) muscle will reduce CMC subluxation of the metacarpal as measured by fluoroscopy.
Methods: Subjects at least 18 years old were recruited. Exclusion criteria included a history of hand arthritis, positive grind test, pregnancy, and major conditions of ligamentous laxity. A certified hand therapist performed a grind test, measured grip and pinch strength, and maximal voluntary contraction of the FDI using the Rotterdam Intrinsic Hand Myometer. Fluoroscopy was used to obtain true AP radiographs of the CMC joint at 1) rest, 2) while stressed without activation of the FDI and 3) while stressed with activation of the FDI. Radial subluxation of the first metacarpal and metacarpal width were measured by 3 blinded surgeons as described by Wolf (2011).
Results: Seventeen subjects with 34 thumbs (5 male and 12 female) participated. Average age was 25.9(21-59). Thirteen right handed, one left handed, and 3 ambidextrous subjects were included. Two thumbs were excluded for a positive grind. Thirty-two thumbs were evaluated. Average maximal voluntary contraction of the FDI was 27N, lateral pinch 81N, and grip strength 347N. Twenty-seven thumbs demonstrated subluxation when stressed with reduction after activation of the FDI. Three thumbs were not subluxed at rest and did not sublux with stress or reduce with firing of the FDI, consistent with stiff CMC joints. Two thumbs were subluxed at rest but did not further sublux with stress. Inter-rater reliability of this categorization was high(ICC>.74). In the 27 thumbs that demonstrated increased subluxation with stress, subluxation while stressed averaged 0.6 cm(0.0-0.9) or 48%(29-75) of articular width. FDI activation reduced subluxation by an average of 0.5 cm(0.1-0.9) or 80%(20-120). The two thumbs with the same degree of subluxation at rest and with stress had subluxation of 0.5 cm and 0.7 cm corresponding to 43% and 63% of articular width, respectively. Reduction with FDI activation was by 0.3 cm and 0.2 cm or 67% and 28%, respectively. When the CMC joint was stressed and FDI activated, maximum FDI strength explained 32.3% of the variability in subluxation.
Conclusion: The FDI radiographically reduces subluxation of the thumb CMC joint. Strengthening the FDI may be an effective intervention in preventing arthritis
Research questions:
1) What are the age and gender stratified normative values of intrinsic hand... more Research questions: 1) What are the age and gender stratified normative values of intrinsic hand strength in persons 50 years or older? 2) Do these stratified samples offer the precision to adequately estimate population means of each measure of intrinsic hand strength? 3) Within adults aged 50+, how do factors known to predict gross grasp strength predict measures of intrinsic hand strength?
Rationale/Background: Intrinsic muscle function can be impacted by hand OA, peripheral nerve injuries, SCI, and ALS. However, intrinsic strength assessment is obscured by extrinsic strength during dynamometry. The Rotterdam Intrinsic Hand Myometer (RIHM) is a reliable and valid intrinsic strength testing device however, no adult normative data is yet available.
Design: Descriptive normative design. Participants were recruited via convenience sampling at a state fair.
Participants: Male and female adults 50 years or older without CNS conditions affecting upper limbs, rheumatological or cardiac conditions, deformity of tested digits, pain during testing, and inability to follow standardized procedures were included. Persons with hand osteoarthritis and musculoskeletal disorders were included.
Methods to Obtain Data: 1) Health and demographic questionnaire 2) Myometry. Using standardized positions, four raters tested first dorsal interosseous (FDI), flexor pollicis brevis (FPB), abductor digiti minimi (ADM), interossei and lumbrical of the 2nd digit (FDI/Lum), and abductor pollicis brevis (APB) strength bilaterally.
Analytical Methods (Sequentially according to research question): 1) Descriptive statistics, tests of skewness and kurtosis, and Shapiro-Wilk’s Test of Normality 2) Power Analysis 3) Backward stepwise mixed-effects linear modeling
Results/Conclusion: 1) Data from 173 participants analyzed (63 males), 52 RIHM measures were normally distributed, and 8 were non-normally distributed. Mean strength greatest in FPB and least in ADM 2) Females (50-69) adequately powered (except dominant FPB). Males adequately powered for 50-59 NDomADM and 70-79 DomADM. Males approached adequate power for ADM and FDI muscles 3) Age, gender (male), and BMI*Gender(male) are significant predictors of strength. Thumb pain is a predictor for FDI strength. Non-significant predictors: hand/arm disorders, BMI (female), and handedness. Models explained 43-60% of variance in intrinsic strength
Discussion: 1) Strength patterns likely due to size and function of the muscles. Intrinsic hand strength declines similarly in both genders 2) Inadequate power for measures of male strength likely due to reduced male volunteerism and higher normal variance in hand anthropometrics 3) Age and gender are significant predictors of intrinsic hand strength. BMI in males was a significant predictor of intrinsic strength. The absence of thumb pain was only a predictor for FDI strength. This supports belief that FDI weakness may correspond with thumb pain/CMC OA. Limitations: Twenty participants omitted weight from survey; thus a multiple imputations analysis was used for missing data. Convenience sampling resulted in an ethnically/racially homogenous sample.
Future Research: 1) Continue recruiting males 2) Expand to include ages 20-49 yrs., more racial/ethnic diversity, and more aged 80+ 3) Expand normative data to include isolated measures of extrinsic muscles 4) Case-control studies using normative data as control and clinical populations as comparison groups (e.g., thumb CMC OA)
Impact Statement: This is a first attempt at establishing strength norms for adult intrinsic hand muscles. These norms can be referenced to evaluate and plan OT interventions for intrinsic weakness. This data may also help to evaluate surgical success of tendon transfers for our clients with nerve palsies and SCI.
Adult intrinsic hand strength norms are not yet reported. We report preliminary data from 5 intrinsic muscles bilaterally in 172 adults aged 50+ years. Upon completion, these norms can be used to evaluate and plan OT interventions for intrinsic weakness and help evaluate success of hand surgery.
Purpose: Work-related musculoskeletal disorders are costing employers approximately 20 million do... more Purpose: Work-related musculoskeletal disorders are costing employers approximately 20 million dollars in direct medical costs, and these costs are continuing to increase at an unsustainable rate. Many measures are used to assess an injured worker’s ability to return to work. One specific measure, the grip strength measure that is taken by hand-held dynamometer, is frequently used as a stand-alone measure or in conjunction with other physical measures for assessing work ability. To this date, a review of the literature has not been performed to assess the accuracy of using a grip strength measurement as a predictor of work ability. The purpose of this scoping review was to examine the literature to assess grip strength as a predictor for work ability Methods: A scoping review was the methodology used for this review of the literature. This method allows for a synthesis of articles that can be used with qualitative or quantitative studies. For this review, the authors used quantitative studies and placed the studies into a qualitative form for the review of the literature. The procedure for the article selection used the method for scoping studies from the Joanne Briggs Institute. The authors compared and discussed charted data. The study results were examined to evaluate trends and gaps that exist in the literature. Supports and barriers were identified and examined with how grip strength relates to work ability. Consensus regarding the themes and key items of information generated from the review was reached between both authors. Results: For this study, 15 articles were analyzed and three themes emerged a) relationship between grip strength and general work ability or return-to-work b) relationship between grip strength and specific job demands or occupations c) relationship between grip strength and task-specific force requirements. In the first them, the results indicate that grip strength has a markedly varying relationship with work ability. Four of the articles in the first theme performed a regression analysis; however, The results from these studies indicate that grip strength as a stand-alone measure yields no information about predictive value related to lost time from work. In the second theme, the authors indicated a positive correlation of varying degrees between grip strength and specific occupations; however, the statistical data does not provide enough evidence to accurately determine the predictive value between grip strength and work ability. In the third theme, the studies focused on a specific job task or activity and a few of these studies had a strong linear relationship; however, the studies did not perform a regression analysis to be able to determine the predictive value or the mathematical equation to determine the effect measure between the independent and dependent variable Conclusion: The findings of this study suggest that grip strength has a markedly varying relationship with work ability. Grip strength appeared to have stronger relationships with specific tasks or work activities that involved gross grip force (e.g., carrying patients, rock climbing) than general work ability or work tasks that account for forces and moments. These differences are reflective in the difference of the grip strength measure and work ability. Grip strength is a measure that is taken at a single point in time. The tasks in some of the various articles reviewed were looking at grip force at a moment in time while performing a specific gripping activity In these cases, a grip strength measure may provide utility since the task is using the specific force that is being measured in a grip strength measure. However, the research does not support what specific measure is required to perform specific tasks. This scoping review determined that there is not enough supporting literature to provide a clear direction on the extent of the predictive value of grip strength as it relates to a multidimensional concept such as work ability. Occupational therapists should continue to use the grip strength measure with caution when determining work ability specifically with evaluations such as a functional capacity evaluation or an impairment rating for determining hand function relative to work ability. A grip strength measure is only a small component of all of the measures necessary to make a determination about work ability. A grip strength measure should be used in combination with other measures for determining work ability until further research proves otherwise. Because there is a paucity of literature on this topic and since the quality of this literature tends to be lower, more quality research including regression analysis models are needed to determine the predictive value of grip strength relative to work ability.
IntroductionGoniometry is a common measure of range of motion and may be assessed by different t... more IntroductionGoniometry is a common measure of range of motion and may be assessed by different therapists and goniometers. To date, there is limited psychometric data on active and passive range of motion measurements of individual thumb joints. The purpose of this study was to analyze inter-rater and inter-instrument reliability of passive and active flexion goniometric measures of thumb joints in healthy adults.MethodsA within-subjects psychometric design was utilized. Two raters each used two goniometers (Baseline™ Flexion-Hyper Extension and Baseline™ 180 Degree Digit) to measure each participant’s (n = 48) thumb carpometacarpal, metacarpophalangeal, and interphalangeal flexion range of motion. Inter-rater and inter-instrument reliability and stability were evaluated through use of intraclass correlation coefficient, standard error of the measurement, and minimal detectable change test statistics.ResultsInter-rater reliability was poor for carpometacarpal flexion and good-to-excellent for metacarpophalangeal and IP flexion. Between-rater error ranged between 3.9 and 6.3 degrees for active measurements and between 3.9 and 7.9 degrees for passive. Error was generally less when using the Baseline™ 180 Degree Digit goniometer. Inter-instrument reliability was excellent for all joints.DiscussionThese findings validate the concerns that thumb goniometry inter-rater reliability may differ in clinical and non-clinical populations, support further study in clinical populations, and support a common assumption that the same rater should test the same client with the same goniometer to minimize measurement error. When compared to the Baseline™ Flexion-Hyper Extension Goniometer, the Baseline™ 180 Degree Digit had higher repeatability across raters. Further research on within-rater reliability is required as is study on clinical populations.
Joint protection for hand osteoarthritis (OA) relies on theory but not empirical evidence. This s... more Joint protection for hand osteoarthritis (OA) relies on theory but not empirical evidence. This study focuses on how hand positioning and nonskid materials influence forces, pain, and perceived effort during jar opening. New data challenge the belief that nonskid materials alone reduce hand forces.
Introduction: Hand therapists selectively strengthen the first dorsal interosseus (FDI) to stabil... more Introduction: Hand therapists selectively strengthen the first dorsal interosseus (FDI) to stabilize arthritic joints yet the role of the FDI has not yet been radiographically validated.
Purpose: To determine if FDI contraction reduces radial subluxation (RS) of the thumb metacarpal (MC).
Methods: Fluoroscopy was used to obtain true anterior-posterior radiographs of non-arthritic CMC joints: 1) at rest, 2) while stressed and 3) while stressed with maximal FDI contraction. Maximal FDI strength during CMC stress and thumb MC RS and trapezial articular width were measured. The ratio of RS to the articular width was calculated.
Results: Seventeen participants (5 male, 12 female) participated. Subluxation of a stressed CMC significantly reduced and the subluxation to articular width ratio significantly improved after FDI activation.
Conclusions: Contraction of the FDI appears to radiographically reduce subluxation of the healthy thumb CMC joint. Further exploration on the FDI's reducibility and its carry-over effects in arthritic thumbs is needed.
The purpose of this study was to assess the relationship between upper extremity strength and the... more The purpose of this study was to assess the relationship between upper extremity strength and the ability to perform instrumental activities of daily living (IADL) independently and to explore how therapists might interpret the results of upper extremity strength evaluations among elderly women. Participants included 29 women (68 to 84 years old) who resided in assisted living facilities. Daily living performance was assessed using five subscales of the Multilevel Assessment Instrument. Grip, lateral pinch, and the strength of selected muscles of the elbow and the shoulder in the dominant upper extremity were tested. Shoulder abductor and external rotator strength were moderately correlated (rs = 0.50 and rs − 0.51, respectively) with IADL function. Shoulder external rotator strength was moderately correlated (rs = 0.55) and elbow extensor strength was fairly correlated (rs = 0.49) with participants' ability to grocery shop. Upper extremity strength measurements within normal limits are not necessarily predictive of IADL independence for elderly women, but measurements below normal limits may indicate IADL limitation. A positive screening result for shoulder weakness or upper extremity strength of more than two standard deviations below norms may warrant in-depth assessment of IADL performance. Alternatively, self-reported limitation in IADL independence may support the need for assessment of upper extremity strength.
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Papers by Corey McGee
Context: Upper quarter injuries have a higher incidence in female swimmers; however, to date, there are few ways to assess the basic functional ability of this region. The upper quarter Y balance test (YBT-UQ) may assist in this process because it was developed to provide a fundamental assessment of dynamic upper quarter ability at the limit of stability. Objective: To examine how sex affects performance on the YBT-UQ in swimmers. Design: Cohort study. Patients or Other Participants: Forty-three male and 54 female National Collegiate Athletic Association Division I college swimmers were recruited preseason. Main Outcome Measure(s): We measured YBT-UQ performance for the left and right limbs in the medial, inferolateral, and superolateral directions. The maximum score for each direction was normalized to upper extremity length. The average of the greatest normalized reach scores in each reach direction was used to develop a composite score (average distance in 3 directions/limb length [LL] x 100). To examine reach symmetry between sexes, the difference in centimeters between the left and right sides was calculated for each reach direction prior to normalization. Statistical analysis was conducted using an independent-samples f test (P Results: Average scores in the medial (women: 92.5 [+ or -] 7.4%LL, men: 100.0 [+ or -] 8.7%LL; P Conclusions: Performance on several YBT-UQ indices was worse for female than male collegiate swimmers. These results may have implications for the use of preseason and return-to-sport testing in swimmers as a measurement of upper quarter function and symmetry. Key Words: Y-Balance test, core stability, shoulder function, injury risk
Butler, Robert, et al. "Sex differences in dynamic closed kinetic chain upper quarter function in collegiate swimmers." Journal of Athletic Training 49.4 (2014): 442+. Academic OneFile. Web. 2 Aug. 2016.
Objectives
To compare sternoclavicular, acromioclavicular, and scapulothoracic joint motion between symptomatic and asymptomatic individuals during shoulder motion performed in 3 planes of humerothoracic elevation.
Background
Differences in scapulothoracic kinematics are associated with shoulder pain. Several studies have measured these differences using surface sensors, but the results of this technique may be affected by skin-motion artifact. Furthermore, previous studies have not included the simultaneous measurement of sternoclavicular and acromioclavicular joint motion.
Methods
Transcortical bone pins were inserted into the clavicle, scapula, and humerus of 12 asymptomatic and 10 symptomatic individuals for direct, bone-fixed tracking using electromagnetic sensors. Angular positions for the sternoclavicular, acromioclavicular, and scapulothoracic joints were measured during shoulder flexion, abduction, and scapular plane abduction.
Results
Differences between groups were found for sternoclavicular and scapulothoracic joint positions. Symptomatic individuals consistently demonstrated less sternoclavicular posterior rotation, regardless of angle, phase, or plane of shoulder motion. Symptomatic individuals also demonstrated less scapulothoracic upward rotation at 30° and 60° of humerothoracic elevation during shoulder abduction and scapular plane abduction.
Conclusion
The results of this study show that differences in shoulder complex kinematics exist between symptomatic and asymptomatic individuals. However, the magnitude of these differences was small, and the resulting clinical implications are not yet fully understood. The biomechanical coupling of the sternoclavicular and acromioclavicular joints requires further research to better understand scapulothoracic movement deviations and to improve manual therapy and exercise-based physical therapy interventions. J Orthop Sports Phys Ther 2014;44(9):636–645. Epub 7 August 2014. doi:10.2519/jospt.2014.5339
BACKGROUND:
There is limited Level-I evidence that compares operative and nonoperative treatment of rotator cuff tears. We compared outcomes of patients treated with primary tendon repair with outcomes of those treated with physiotherapy and optional secondary tendon repair if needed.
METHODS:
A single-center, pragmatic, randomized controlled study with follow-ups after six months and one, two, and five years was conducted in a secondary-care institution. One hundred and three patients with a rotator cuff tear not exceeding 3 cm were randomized to primary tendon repair (n = 52) or physiotherapy (n = 51). The primary outcome measure was the Constant score. Secondary outcome measures included the self-report section of the American Shoulder and Elbow Surgeons score; the physical component summary measure of the Short Form 36 Health Survey; the measurement of pain, strength, and shoulder motion; patient satisfaction; and findings from magnetic resonance imaging and sonography. Analysis was by intention to treat.
RESULTS:
The five-year follow-up rate was 98%. Twelve of the fifty-one patients in the physiotherapy group were treated with secondary tendon repair. The results from primary tendon repair were superior to those from physiotherapy plus secondary repair, with between-group mean differences of 5.3 points on the Constant score (p = 0.05), 9.0 points on the American Shoulder and Elbow Surgeons score (p < 0.001), 1.1 cm on a 10-cm visual analog scale for pain (p < 0.001), and 1.0 cm on a 10-cm visual analog scale for patient satisfaction (p = 0.03). In 37% of tears treated with physiotherapy only, there were increasing tear sizes on ultrasound of >5 mm, over five years, associated with an inferior outcome.
CONCLUSIONS:
Although primary repair of small and medium-sized rotator cuff tears was associated with better outcome than physiotherapy treatment, the differences were small and may be below clinical importance. In the physiotherapy treatment group, there were increasing tear sizes and inferior outcomes in one-third of patients who did not undergo repair.
This article provides video and narration to describe the technical details of how to inject local anesthesia and perform the extensor indicis proprius to extensor pollicis longus tendon transfer in patients with wide-awake local anesthesia and no tourniquet. Lidocaine for anesthesia and epinephrine for hemostasis are the only 2 medications given to the patient. Sedation and the tourniquet are not required. Wide-awake patients are comfortable, cooperative, and educable, and are able to help the surgeon set the correct tension for the transfer. They flex and extend the thumb before the skin is closed to make sure the transfer is not too tight or too loose. It helps that they remember seeing the thumb move nicely during the surgery when they are in postoperative hand therapy.
will reduce CMC subluxation of the metacarpal as measured by fluoroscopy.
METHODS. Subjects at least 18 years old were recruited. Exclusion criteria included a history of hand arthritis, positive grind test, pregnancy, and major conditions of ligamentous laxity. A certified hand therapist performed a grind test, measured grip and pinch strength, and maximal voluntary contraction of the FDI using the Rotterdam Intrinsic Hand Myometer. Fluoroscopy was used to obtain true AP radiographs of the CMC joint at 1) rest, 2) while stressed without activation of the FDI and 3) while stressed with activation of the FDI. Radial subluxation of the first metacarpal and metacarpal width were measured by 3 blinded surgeons as described by Wolf (2011).
RESULTS. Seventeen subjects with 34 thumbs (5 male and 12 female) participated. Average age was 25.9(21-59). Thirteen right handed, one left handed, and 3 ambidextrous subjects were included. Two thumbs were excluded for a positive grind. Thirty-two thumbs were evaluated. Average maximal voluntary contraction of the FDI was 27N, lateral
pinch 81N, and grip strength 347N. Twenty-seven thumbs demonstrated subluxation when stressed with reduction after activation of the FDI. Three thumbs were not subluxed at rest and did not sublux with stress or reduce with firing of the FDI, consistent with stiff CMC joints. Two thumbs were subluxed at rest but did not further sublux with stress. Inter-rater reliability of this categorization was high(ICC>.74).
In the 27 thumbs that demonstrated increased subluxation with stress, subluxation while stressed averaged 0.6 cm(0.0- 0.9) or 48%(29-75) of articular width. FDI activation reduced subluxation by an average of 0.5 cm(0.1-0.9) or 80%(20- 120). The two thumbs with the same degree of subluxation at rest and with stress had subluxation of 0.5 cm and 0.7
cm corresponding to 43% and 63% of articular width, respectively. Reduction with FDI activation was by 0.3 cm and 0.2 cm or 67% and 28%, respectively. When the CMC joint was stressed and FDI activated, maximum FDI strength explained 32.3% of the variability in subluxation.
DISCUSSION. The FDI radiographically reduces subluxation of the thumb CMC joint. Strengthening the FDI may be an effective intervention in preventing arthritis.
Methods: Subjects at least 18 years old were recruited. Exclusion criteria included a history of hand arthritis, positive grind test, pregnancy, and major conditions of ligamentous laxity. A certified hand therapist performed a grind test, measured grip and pinch strength, and maximal voluntary contraction of the FDI using the Rotterdam Intrinsic Hand Myometer. Fluoroscopy was used to obtain true AP radiographs of the CMC joint at 1) rest, 2) while stressed without activation of the FDI and 3) while stressed with activation of the FDI. Radial subluxation of the first metacarpal and metacarpal width were measured by 3 blinded surgeons as described by Wolf (2011).
Results: Seventeen subjects with 34 thumbs (5 male and 12 female) participated. Average age was 25.9(21-59). Thirteen right handed, one left handed, and 3 ambidextrous subjects were included. Two thumbs were excluded for a positive grind. Thirty-two thumbs were evaluated. Average maximal voluntary contraction of the FDI was 27N, lateral pinch 81N, and grip strength 347N. Twenty-seven thumbs demonstrated subluxation when stressed with reduction after activation of the FDI. Three thumbs were not subluxed at rest and did not sublux with stress or reduce with firing of the FDI, consistent with stiff CMC joints. Two thumbs were subluxed at rest but did not further sublux with stress. Inter-rater reliability of this categorization was high(ICC>.74). In the 27 thumbs that demonstrated increased subluxation with stress, subluxation while stressed averaged 0.6 cm(0.0-0.9) or 48%(29-75) of articular width. FDI activation reduced subluxation by an average of 0.5 cm(0.1-0.9) or 80%(20-120). The two thumbs with the same degree of subluxation at rest and with stress had subluxation of 0.5 cm and 0.7 cm corresponding to 43% and 63% of articular width, respectively. Reduction with FDI activation was by 0.3 cm and 0.2 cm or 67% and 28%, respectively. When the CMC joint was stressed and FDI activated, maximum FDI strength explained 32.3% of the variability in subluxation.
Conclusion: The FDI radiographically reduces subluxation of the thumb CMC joint. Strengthening the FDI may be an effective intervention in preventing arthritis.
First Dorsal Interosseous (FDI) muscle will radiographically reduce subluxation of the 1st metacarpal relative to the trapezium.
METHODS: Subjects at least 18 years old were recruited. Exclusion criteria included positive grind test, pregnancy, and major conditions of ligamentous laxity. A certified hand therapist performed a grind test on all subjects. Using a hand-held manometer, maximal voluntary
contraction of the FDI as measured by the Rotterdam Intrinsic Myometer; lateral pinch strength, and grip strength were measured. Fluoroscopy was used to obtain true AP radiographs of the
CMC joint at (1) rest, (2) while stressed without activation of the FDI, and (3) while stressed with activation of the FDI. Radial subluxation of the base of the first metacarpal and metacarpal width
were measured by 3 blinded surgeons as described by Wolf (2011). The ratio of radial subluxation to the articular width was calculated.
RESULTS: Seventeen subjects with 34 thumbs including 5 males and 12 females participated. Average age was 25.9 (21-59). Thirteen right-handed, 1 left-handed, and 3 ambidextrous subjects were included. Two thumbs were excluded for a positive grind and one for poor
radiograph quality. Thirty-one thumbs were evaluated. Average maximal voluntary contraction of the FDI was 27N, lateral pinch 81N, and grip strength 347N. Twenty-six thumbs demonstrated subluxation when stressed and reduction after firing of the
FDI. Three thumbs were not subluxed at rest and did not sublux with stress, consistent with stiff CMC joints. Two thumbs were subluxed at rest but did not further sublux with stress. Inter-rater reliability was high (96%). In the 26 thumbs that demonstrated increased subluxation with stress, subluxation while stressed averaged 48% (29-75) of metacarpal articular width. FDI activation reduced subluxation by an average of 80% (20-120). The two thumbs with the same degree of subluxation at rest and with stress had subluxation 43% and 63% of articular width. Reduction with FDI activation was 67% and 28%, respectively.
CONCLUSION: The FDI radiographically reduces subluxation of the thumb CMC joint.Strengthening the FDI may be effective in preventing thumb arthritis.
Methods: Subjects at least 18 years old were recruited. Exclusion criteria included a history of hand arthritis, positive grind test, pregnancy, and major conditions of ligamentous laxity. A certified hand therapist performed a grind test, measured grip and pinch strength, and maximal voluntary contraction of the FDI using the Rotterdam Intrinsic Hand Myometer. Fluoroscopy was used to obtain true AP radiographs of the CMC joint at 1) rest, 2) while stressed without activation of the FDI and 3) while stressed with activation of the FDI. Radial subluxation of the first metacarpal and metacarpal width were measured by 3 blinded surgeons as described by Wolf (2011).
Results: Seventeen subjects with 34 thumbs (5 male and 12 female) participated. Average age was 25.9(21-59). Thirteen right handed, one left handed, and 3 ambidextrous subjects were included. Two thumbs were excluded for a positive grind. Thirty-two thumbs were evaluated. Average maximal voluntary contraction of the FDI was 27N, lateral pinch 81N, and grip strength 347N. Twenty-seven thumbs demonstrated subluxation when stressed with reduction after activation of the FDI. Three thumbs were not subluxed at rest and did not sublux with stress or reduce with firing of the FDI, consistent with stiff CMC joints. Two thumbs were subluxed at rest but did not further sublux with stress. Inter-rater reliability of this categorization was high(ICC>.74). In the 27 thumbs that demonstrated increased subluxation with stress, subluxation while stressed averaged 0.6 cm(0.0-0.9) or 48%(29-75) of articular width. FDI activation reduced subluxation by an average of 0.5 cm(0.1-0.9) or 80%(20-120). The two thumbs with the same degree of subluxation at rest and with stress had subluxation of 0.5 cm and 0.7 cm corresponding to 43% and 63% of articular width, respectively. Reduction with FDI activation was by 0.3 cm and 0.2 cm or 67% and 28%, respectively. When the CMC joint was stressed and FDI activated, maximum FDI strength explained 32.3% of the variability in subluxation.
Conclusion: The FDI radiographically reduces subluxation of the thumb CMC joint. Strengthening the FDI may be an effective intervention in preventing arthritis
1) What are the age and gender stratified normative values of intrinsic hand strength in persons 50 years or older?
2) Do these stratified samples offer the precision to adequately estimate population means of each measure of intrinsic hand strength?
3) Within adults aged 50+, how do factors known to predict gross grasp strength predict measures of intrinsic hand strength?
Rationale/Background: Intrinsic muscle function can be impacted by hand OA, peripheral nerve injuries, SCI, and ALS. However, intrinsic strength assessment is obscured by extrinsic strength during dynamometry. The Rotterdam Intrinsic Hand Myometer (RIHM) is a reliable and valid intrinsic strength testing device however, no adult normative data is yet available.
Design: Descriptive normative design. Participants were recruited via convenience sampling at a state fair.
Participants: Male and female adults 50 years or older without CNS conditions affecting upper limbs, rheumatological or cardiac conditions, deformity of tested digits, pain during testing, and inability to follow standardized procedures were included. Persons with hand osteoarthritis and musculoskeletal disorders were included.
Methods to Obtain Data:
1) Health and demographic questionnaire
2) Myometry. Using standardized positions, four raters tested first dorsal interosseous (FDI), flexor pollicis brevis (FPB), abductor digiti minimi (ADM), interossei and lumbrical of the 2nd digit (FDI/Lum), and abductor pollicis brevis (APB) strength bilaterally.
Analytical Methods (Sequentially according to research question):
1) Descriptive statistics, tests of skewness and kurtosis, and Shapiro-Wilk’s Test of Normality
2) Power Analysis
3) Backward stepwise mixed-effects linear modeling
Results/Conclusion:
1) Data from 173 participants analyzed (63 males), 52 RIHM measures were normally distributed, and 8 were non-normally distributed. Mean strength greatest in FPB and least in ADM
2) Females (50-69) adequately powered (except dominant FPB). Males adequately powered for 50-59 NDomADM and 70-79 DomADM. Males approached adequate power for ADM and FDI muscles
3) Age, gender (male), and BMI*Gender(male) are significant predictors of strength. Thumb pain is a predictor for FDI strength. Non-significant predictors: hand/arm disorders, BMI (female), and handedness. Models explained 43-60% of variance in intrinsic strength
Discussion:
1) Strength patterns likely due to size and function of the muscles. Intrinsic hand strength declines similarly in both genders
2) Inadequate power for measures of male strength likely due to reduced male volunteerism and higher normal variance in hand anthropometrics
3) Age and gender are significant predictors of intrinsic hand strength. BMI in males was a significant predictor of intrinsic strength. The absence of thumb pain was only a predictor for FDI strength. This supports belief that FDI weakness may correspond with thumb pain/CMC OA.
Limitations: Twenty participants omitted weight from survey; thus a multiple imputations analysis was used for missing data. Convenience sampling resulted in an ethnically/racially homogenous sample.
Future Research:
1) Continue recruiting males
2) Expand to include ages 20-49 yrs., more racial/ethnic diversity, and more aged 80+
3) Expand normative data to include isolated measures of extrinsic muscles
4) Case-control studies using normative data as control and clinical populations as comparison groups (e.g., thumb CMC OA)
Impact Statement: This is a first attempt at establishing strength norms for adult intrinsic hand muscles. These norms can be referenced to evaluate and plan OT interventions for intrinsic weakness. This data may also help to evaluate surgical success of tendon transfers for our clients with nerve palsies and SCI.
Adult intrinsic hand strength norms are not yet reported. We report preliminary data from 5 intrinsic muscles bilaterally in 172 adults aged 50+ years. Upon completion, these norms can be used to evaluate and plan OT interventions for intrinsic weakness and help evaluate success of hand surgery.
Methods: A scoping review was the methodology used for this review of the literature. This method allows for a synthesis of articles that can be used with qualitative or quantitative studies. For this review, the authors used quantitative studies and placed the studies into a qualitative form for the review of the literature. The procedure for the article selection used the method for scoping studies from the Joanne Briggs Institute. The authors compared and discussed charted data. The study results were examined to evaluate trends and gaps that exist in the literature. Supports and barriers were identified and examined with how grip strength relates to work ability. Consensus regarding the themes and key items of information generated from the review was reached between both authors.
Results: For this study, 15 articles were analyzed and three themes emerged a) relationship between grip strength and general work ability or return-to-work b) relationship between grip strength and specific job demands or occupations c) relationship between grip strength and task-specific force requirements. In the first them, the results indicate that grip strength has a markedly varying relationship with work ability. Four of the articles in the first theme performed a regression analysis; however, The results from these studies indicate that grip strength as a stand-alone measure yields no information about predictive value related to lost time from work. In the second theme, the authors indicated a positive correlation of varying degrees between grip strength and specific occupations; however, the statistical data does not provide enough evidence to accurately determine the predictive value between grip strength and work ability. In the third theme, the studies focused on a specific job task or activity and a few of these studies had a strong linear relationship; however, the studies did not perform a regression analysis to be able to determine the predictive value or the mathematical equation to determine the effect measure between the independent and dependent variable
Conclusion:
The findings of this study suggest that grip strength has a markedly varying relationship with work ability. Grip strength appeared to have stronger relationships with specific tasks or work activities that involved gross grip force (e.g., carrying patients, rock climbing) than general work ability or work tasks that account for forces and moments. These differences are reflective in the difference of the grip strength measure and work ability. Grip strength is a measure that is taken at a single point in time. The tasks in some of the various articles reviewed were looking at grip force at a moment in time while performing a specific gripping activity In these cases, a grip strength measure may provide utility since the task is using the specific force that is being measured in a grip strength measure. However, the research does not support what specific measure is required to perform specific tasks. This scoping review determined that there is not enough supporting literature to provide a clear direction on the extent of the predictive value of grip strength as it relates to a multidimensional concept such as work ability. Occupational therapists should continue to use the grip strength measure with caution when determining work ability specifically with evaluations such as a functional capacity evaluation or an impairment rating for determining hand function relative to work ability. A grip strength measure is only a small component of all of the measures necessary to make a determination about work ability. A grip strength measure should be used in combination with other measures for determining work ability until further research proves otherwise. Because there is a paucity of literature on this topic and since the quality of this literature tends to be lower, more quality research including regression analysis models are needed to determine the predictive value of grip strength relative to work ability.
Purpose: To determine if FDI contraction reduces radial subluxation (RS) of the thumb metacarpal (MC).
Methods: Fluoroscopy was used to obtain true anterior-posterior radiographs of non-arthritic CMC joints: 1) at rest, 2) while stressed and 3) while stressed with maximal FDI contraction. Maximal FDI strength during CMC stress and thumb MC RS and trapezial articular width were measured. The ratio of RS to the articular width was calculated.
Results: Seventeen participants (5 male, 12 female) participated. Subluxation of a stressed CMC significantly reduced and the subluxation to articular width ratio significantly improved after FDI activation.
Conclusions: Contraction of the FDI appears to radiographically reduce subluxation of the healthy thumb CMC joint. Further exploration on the FDI's reducibility and its carry-over effects in arthritic thumbs is needed.