Hand Surgery Source

Grip Strength

Test, Exam and Signs

Description

  • Hand grip strength indicates muscle strength and can be measured with a Jamar hydraulic hand dynamometer.1 The Jamar dynamometer can assess hand strength to the nearest 1 kg.2
  • Studies have shown that using the second handle position on the dynamometer is most efficient.3
  • Typical grip strength varies from one person to another. It is preferable to measure the strength of the contralateral hand, rather than comparing measurements among patients. Most people have ~20% more strength in their dominant hand.1

Pathophysiology

  • Grip strength below two standard deviations of the mean may be a sign of carpal tunnel syndrome, cubital tunnel syndrome, cervical radiculopathy, wrist osteoarthritis, rheumatoid arthritis (RA), or Kienbock’s disease.
  • The patient’s grip strength may be affected by muscle atrophy or recent injuries.4

Instructions

  1. Record the patient’s history, including any sports-related injuries. Ask the patient to rate on a scale from 1 to 10, how much pain s/he usually experiences in the affected hand.
  2. Ask the patient to sit with his/her shoulder adducted and neutrally rotated, elbow flexed at 90°, forearm in neutral position, and wrist with 0–30° dorsiflexion and 0–15° ulnar deviation.
  3. Adjust the Jamar dynamometer to the second handle position.3
  4. Ask the patient to grip the dynamometer using cylindrical grasp for 3 successive trials. Measure the grip strength of each trial.1
  5. Repeat the process for the contralateral hand.

Variations

  • The rapid exchange grip test is a variation on the grip strength test that can help to evaluate submaximal grip effort. Perform this test while rapidly exchanging from one side to another.1,5

Related Signs and Tests

  • Tenderness with palpation
  • Range of motion, active
  • Range of motion, passive
  • Pinch strength

Diagnostic Performance Characteristics

  • The Jamar dynamometer facilitates a reliable measure of isometric grip strength in motivated patients.5
  • To improve reliability, also use the rapid exchange grip test.
Presentation Photos and Related Diagrams
  • Measuring grip strength with Jamar Dynamometer
    Measuring grip strength with Jamar Dynamometer
  • Measuring grip strength with Jamar Dynamometer
    Measuring grip strength with Jamar Dynamometer
Definition of Positive Result
  • A positive result usually occurs when the grip strength is below 2 standard deviations of the mean. When analyzing the result, make sure to consider previous traumas and/or surgeries. 
Definition of Negative Result
  • A negative result occurs when the grip strength is within 2 standard deviations of the mean.
Comments and Pearls
  • Normal grip strength varies from individual to individual.
  • Always compare affected to unaffect extremities before concluding that the strength is normal or abnormal.
  • Reminder the patient's effort is controlled by the patient and not by the examiner.
  • Submaximal grip effort is difficult to assess even with rapid exchange grip strength testing.2,5.    
  • Patterns of grip strength may be affected by age, gender, nutritional status, lifestyle, and anthropometric traits.2 
Diagnoses Associated with Tests, Exams and Signs
References
  1. Culp R, Jacoby S. Musculoskeletal Examination of the Elbow, Wrist and Hand: Making the Complex Simple.  New Jersey: SLACK Incorporated, 2012.
  2. Cha SM, Shin HD, Kim KC, Park JW. Comparison of grip strength among 6 grip methods. J Hand Surg Am 2014;39(11):2277-84. PMID: 25085045
  3. Trampisch US, Franke J, Jedamzik N, et al. Optimal Jamar dynamometer handle position to assess maximal isometric hand grip strength in epidemiological studies. J Hand Surg Am 2012;37(11):2368-73. PMID: 23101534
  4. Rayan G, Akelman E. The Hand: Anatomy, Examination and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012.
  5. Westbrook AP, Tredgett MW, Davis TR, 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

Review Articles

  1. Bot, A., Mulders, M., Fostvedt, S., & Ring, D. (2012). Determinants of Grip Strength in Healthy Subjects Compared to That in Patients Recovering From a Distal Radius Fracture. The Journal of Hand Surgery,37A, 1874-1880.
  2. Klum, M., Wolf, M., Hahn, P., Leclère, F., Bruckner, T., & Unglaub, F. (2012). Normative Data on Wrist Function. The Journal of Hand Surgery,37A, 2050-2060.