Strength measurements of the intrinsic and extrinsic hand muscles in peripheral nerve injury : the Rotterdam Intrinsic Hand Myometer (RIHM)
Schreuders, Ton A. R. ...
Numerous neurological diseases are accompanied by atrophy of the intrinsic muscles of the hand. Muscle function strength testing of these muscles is frequently used for clinical decision making in ...these patients. These strength measurements have generally focused on pinch and grip strength dynamometry or on manual muscle stength testing (MMST). We have developed Rotterdam Intrinsic Hand Myometer (RIHM) to measure the muscle force of the intrinsic muscles with a hand-held device. The RIHM allows measuring of the abduction of the little finger and index finger. In addition, the opposition and palmar abduction of the thumb can be measured to assess both median and ulnar nerve innervated intrinsic muscles. Reliability of measurements with the RIHM in nerve injury patients was comparable to grip and pinch strength measurements and is acceptable to study the recovery and function of the intrinsic muscles of the hand in isolation. We have applied the RIHM in a recent study on the long term outcome of muscle strength in patient with ulnar and median nerve injuries, in which we found that the intrinsic muscles recover to grade 3 or 4 on the MMST. In addition, recovery of grip and pinch strength was relatively high. However, the RIHM measurements revealed a poor recovery of especially the ulnar nerve innervated muscles. This poor recovery could not be detected with MMST measurements or with pinch and grip dynamometry. We conclude that the RIHM dynamometer provides an accurate clinical assessment of the muscle strength of the intrinsic hand muscles. The RIHM provides more quantitative results than manual muscle strength testing, especially in the range of Medical Research Council grades 4 and 5.
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