Mateusz Gładysz FESSH prep

FESSH prep Physical examination Mean of three trials for test–retest reliability, elbow position, the 10% dominance rule and handedness, the rapid exchange grip test for submaximal effort, age related normative patterns of grip and pinch

Measurement of grip and pinch strength

Last reviewed v1.0

FESSH-088Physical examination●●○ intermediate

Regarding the measurement and interpretation of grip and pinch strength:

  1. 1.Test–retest reliability of grip and pinch strength is highest when the mean of three trials is recorded, rather than a single trial or the highest of three.

  2. 2.Elbow position need not be kept consistent when comparing serial grip-strength measurements.

  3. 3.The '10% rule', that the dominant hand grips about 10% more strongly, applies equally to right-handed and left-handed people.

  4. 4.The rapid exchange grip test cannot reliably detect voluntary submaximal effort.

  5. 5.In adult normative data, grip strength correlates more closely with age than pinch strength does.

FESSH marking: +1 per correct statement, 0 for blank, −1 for incorrect. Click the same TRUE/FALSE button twice to clear it.

Question ID
FESSH-088
First published
Last reviewed
Version
v1.0
Answer key and explanations — open after answering

  1. 1. Test–retest reliability of grip and pinch strength is highest when the mean of three trials is recorded, rather than a single trial or the highest of three.

    True

    Mathiowetz and colleagues tested grip, palmar pinch, key pinch and tip pinch in 27 women using standardised positioning and instructions. Inter-rater reliability was very high, and test–retest reliability was highest for all four tests when the mean of three trials was used; correlations were lower for a single trial or for the highest of three.

    • Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am. 1984;9(2):222-6. PMID 6715829

  2. 2. Elbow position need not be kept consistent when comparing serial grip-strength measurements.

    False

    Elbow position can alter recorded grip strength. Reports differ on whether readings are higher in flexion or extension, so serial assessments should use a consistent elbow position and testing conditions.

    • Balogun JA, Akomolafe CT, Amusa LO. Grip strength: effects of testing posture and elbow position. Archives of physical medicine and rehabilitation. 1991;72(5):280-3. PMID 2009042
    • Mathiowetz V, Rennells C, Donahoe L. Effect of elbow position on grip and key pinch strength. J Hand Surg Am. 1985;10(5):694-7. PMID 4045150
    • Su CY, Lin JH, Chien TH, Cheng KF, Sung YT. Grip strength in different positions of elbow and shoulder. Archives of physical medicine and rehabilitation. 1994;75(7):812-5. PMID 8024431

  3. 3. The '10% rule', that the dominant hand grips about 10% more strongly, applies equally to right-handed and left-handed people.

    False

    In 310 students and staff, Petersen and colleagues found an overall dominant–non-dominant grip difference of 10.74%, but 12.72% in right-handed and −0.08% in left-handed subjects; they concluded that the rule holds only for right-handed people and that grip should be considered equal in both hands of left-handed people. Armstrong and Oldham found much smaller differences (0.1–3%) in right-handed participants, no significant difference in left-handed participants and wide individual variability, and advise caution in applying the rule.

    • Petersen P, Petrick M, Connor H, Conklin D. Grip strength and hand dominance: challenging the 10% rule. Am J Occup Ther. 1989;43(7):444-7. PMID 2750859
    • Armstrong CA, Oldham JA. A comparison of dominant and non-dominant hand strengths. J Hand Surg Br. 1999;24(4):421-5. PMID 10473148

  4. 4. The rapid exchange grip test cannot reliably detect voluntary submaximal effort.

    True

    Westbrook and colleagues compared 50 normal participants giving maximal and then feigned effort with 50 patients recovering from carpal tunnel surgery: the dynamic measure equalled or exceeded the static measure in 74% of feigned efforts but also in 58% of the genuine patients. Shechtman and Taylor found relatively low sensitivity and specificity, suggesting that the test may not detect sincerity of effort reliably, and Vollert and colleagues found no grip parameter that could identify feigned weakness in an individual case.

    • Westbrook AP, Tredgett MW, Davis TRC, Oni JA. The rapid exchange grip strength test and the detection of submaximal grip effort. J Hand Surg Am. 2002;27(2):329-33. PMID 11901394
    • Shechtman O, Taylor C. The use of the rapid exchange grip test in detecting sincerity of effort, Part II: validity of the test. J Hand Ther. 2000;13(3):203-10. PMID 10966140
    • Vollert J, Pasqualicchio C, Papenhoff M, Heitmann B, Müller F, Maier C. Grip strength feigning is hard to detect: an exploratory study. J Hand Surg Eur Vol. 2018;43(2):193-198. PMID 28853619

  5. 5. In adult normative data, grip strength correlates more closely with age than pinch strength does.

    True

    Mathiowetz and colleagues tested 310 men and 328 women aged 20 to 94 years. Grip strength peaked in the 25–39-year age groups and correlated highly with age, whereas tip, key and palmar pinch were relatively stable from 20 to 59 years and correlated only low to moderately with age. Their age- and sex-stratified values allow a patient to be compared with normal subjects of the same age and sex.

    • Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66(2):69-74. PMID 3970660