Surgical Treatment of Cervical Spondylotic Myelopathy Leads to Functional Improvement in Hand Strength and Dexterity: A Prospective Quantitative Study

Abstract INTRODUCTION Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in adults. The goal of this study was to establish the functional impact of CSM severity on hand function using quantitative testing and evaluate the response to intervention. METHODS A total of 33 consecutive patients planned for surgical treatment of CSM were prospectively enrolled. A licensed occupational therapist conducted 3 functional hand tests: 1) palmar dynamometry to assess grip strength, 2) hydraulic pinch gauge test to assess pinch strength, and 3) 9-hole peg test to assess upper extremity dexterity. Tests were performed preoperatively and at 6 to 8 wk postoperatively. Patients were stratified into mild, moderate, and severe myelopathy based on modified Japanese Orthopedic Association (mJOA) score. RESULTS 61% patients underwent anterior approach decompression with mean of 2.9 ± 1.5 levels treated. Preoperative pinch (P < .001) and grip (P = .014) strength were lower in moderate and low mJOA patients compared to high mJOA patients. Significant postoperative improvement was observed in all hand function domains with MCI improvement at 6 wk ranging from 33% of patients in dominant strength tests to 72% of patients in nondominant dexterity tests; patients with moderate baseline mJOA were more likely to have MCI improvement in dominant grip (58.3%) compared to low (30%) and high (9%) mJOA groups (P = .041). Dexterity as measured by mean dominant peg percentile was less than 1 in patients with cord signal change increasing in percentile to 15.7 with only subarachnoid effacement (P = .032). CONCLUSION CSM patients achieved significant improvement in strength and dexterity postoperatively. Baseline strength measures correlated most with preoperative mJOA, however baseline dexterity correlated most with severity of stenosis on MRI. Baseline pinch strength correlated with postoperative mJOA MCI improvement, and patients with moderate baseline mJOA were the most likely to have improvement in dominant grip strength postoperatively.

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Functional improvement in hand strength and dexterity after surgical treatment of cervical spondylotic myelopathy: a prospective quantitative study

Journal of Neurosurgery Spine ◽

10.3171/2019.10.spine19685 ◽

2020 ◽

Vol 32 (6) ◽

pp. 907-913

Author(s):

Tyler S. Cole ◽

Kaith K. Almefty ◽

Jakub Godzik ◽

Amy H. Muma ◽

Randall J. Hlubek ◽

...

Keyword(s):

Surgical Treatment ◽

Grip Strength ◽

Upper Extremity ◽

Cervical Spondylotic Myelopathy ◽

Hand Function ◽

Hand Strength ◽

Pinch Strength ◽

Dominant Hand ◽

Nondominant Hand ◽

The Impact

OBJECTIVECervical spondylotic myelopathy (CSM) is the primary cause of adult spinal cord dysfunction. Diminished hand strength and reduced dexterity associated with CSM contribute to disability. Here, the authors investigated the impact of CSM severity on hand function using quantitative testing and evaluated the response to surgical intervention.METHODSThirty-three patients undergoing surgical treatment of CSM were prospectively enrolled in the study. An occupational therapist conducted 3 functional hand tests: 1) palmar dynamometry to measure grip strength, 2) hydraulic pinch gauge test to measure pinch strength, and 3) 9-hole peg test (9-HPT) to evaluate upper extremity dexterity. Tests were performed preoperatively and 6–8 weeks postoperatively. Test results were expressed as 1) a percentile relative to age- and sex-stratified norms and 2) achievement of a minimum clinically important (MCI) difference. Patients were stratified into groups (mild, moderate, and severe myelopathy) based on their modified Japanese Orthopaedic Association (mJOA) score. The severity of stenosis on preoperative MRI was graded by three independent physicians using the Kang classification.RESULTSThe primary presenting symptoms were neck pain (33%), numbness (21%), imbalance (12%), and upper extremity weakness (12%). Among the 33 patients, 61% (20) underwent anterior approach decompression, with a mean (SD) of 2.9 (1.5) levels treated. At baseline, patients with moderate and low mJOA scores (indicating more severe myelopathy) had lower preoperative pinch (p < 0.001) and grip (p = 0.01) strength than those with high mJOA scores/mild myelopathy. Postoperative improvement was observed in all hand function domains except pinch strength in the nondominant hand, with MCI differences at 6 weeks ranging from 33% of patients in dominant-hand strength tests to 73% of patients in nondominant-hand dexterity tests. Patients with moderate baseline mJOA scores were more likely to have MCI improvement in dominant grip strength (58.3%) than those with low mJOA scores/severe myelopathy (30%) and high mJOA scores/mild myelopathy (9%, p = 0.04). Dexterity in the dominant hand as measured by the 9-HPT ranged from < 1 in patients with cord signal change to 15.9 in patients with subarachnoid effacement only (p = 0.03).CONCLUSIONSPatients with CSM achieved significant improvement in strength and dexterity postoperatively. Baseline strength measures correlated best with the preoperative mJOA score; baseline dexterity correlated best with the severity of stenosis on MRI. The majority of patients experienced MCI improvements in dexterity. Baseline pinch strength correlated with postoperative mJOA MCI improvement, and patients with moderate baseline mJOA scores were the most likely to have improvement in dominant grip strength postoperatively.

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A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization: An orthosis that promotes function and improvement in patients with the first carpometacarpal joint osteoarthritis

Prosthetics and Orthotics International ◽

10.1177/0309364613488621 ◽

2013 ◽

Vol 38 (1) ◽

pp. 79-82 ◽

Cited By ~ 10

Author(s):

Monireh Ahmadi Bani ◽

Mokhtar Arazpour ◽

Stephen William Hutchins ◽

Fereydoun Layeghi ◽

Mahmood Bahramizadeh ◽

...

Keyword(s):

Grip Strength ◽

Clinical Relevance ◽

Hand Function ◽

Pinch Strength ◽

Conservative Approach ◽

Carpometacarpal Joint ◽

Custom Made ◽

First Carpometacarpal Joint ◽

Thumb Carpometacarpal ◽

Improved Function

Background and aim: Patients with mild to moderate first carpometacarpal joint osteoarthritis report pain, a reduction in pinch and grip strength and hand function. The purpose of this study was to analyze the effect of a custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization on pain, function, grip strength, and key pinch in these patients. Technique: A total of 11 volunteer patients participated in this study. All the above-mentioned parameters were evaluated at baseline and also 30, 60, and 90 days after using the splint. Discussion: A decrease in pain was observed after 30 days, and this continued to improve during treatment with the splint. After 90 days of using the splint, grip strength was improved. Function and pinch strength also increased significantly and was maintained during the study period compared to baseline. Clinical relevance A custom-made neoprene thumb carpometacarpal orthosis with thermoplastic stabilization may be a suitable conservative approach for the treatment of first carpometacarpal joint osteoarthritis.

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Can upper limb taping or exercises improve hand function, writing speed and self-perception of performance in adolescent school children?

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2018-0065 ◽

2018 ◽

Vol 0 (0) ◽

Author(s):

Hiba Memon ◽

Apurv Shimpi ◽

Ashok Shyam ◽

Parag Sancheti

Keyword(s):

Grip Strength ◽

School Children ◽

Hand Function ◽

Group Analysis ◽

Performance Measure ◽

Pinch Strength ◽

Self Perception ◽

Urban City ◽

Significant Difference ◽

Non Parametric

Abstract Background The majority of students spend time in writing, which is a prime performance measure in examinations. Enhancement in handwriting should benefit students to attain better academic performance. Objective To assess the effectiveness of taping and exercises on hand function, writing speed, self-perception of writing and to compare these techniques. Methods A randomized control trial was conducted using cluster sampling in adolescent children across four schools in an urban city. A 4-week intervention study was conducted on 123 students divided into taping, exercise and control groups. Outcome measures were grip strength, pinch strength, 12-min writing speed test and the Writer Self-Perception Scale (WSPS). For intra-group analysis, a paired t-test was used for parametric values and the Wilcoxon signed rank test was used for non-parametric values. For inter-group analysis, one-way analysis of variance (ANOVA) for parametric values and the Kruskal-Wallis test for non-parametric values was used. Results The taping group showed a significant improvement in grip strength (1.79 kg; p = 0.00), pinch strength [1.67 lb (757.4 g); p = 0.00] and writing speed (39.77 words/12 min; p = 0.00). The exercise group showed significant improvement in grip strength (2.09 kg; p = 0.00), pinch strength (1.28 lb; p = 0.00), writing speed (28.38 words/12 min; p = 0.00). In the control group, there was a significant increase in pinch strength (1.023 lb; p = 0.01) and writing speed (12.94 words/12 min; p = 0.02). Inter-group analysis showed significant difference in writing speed (p = 0.002) and grip strength (p = 0.00). There was no significant difference in perception (p = 0.071). Conclusion Taping and exercise are equally effective for enhancement of hand function, writing speed and self-perception in adolescent school children.

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The effect of custom-made splints in patients with the first carpometacarpal joint osteoarthritis

Prosthetics and Orthotics International ◽

10.1177/0309364612454047 ◽

2012 ◽

Vol 37 (2) ◽

pp. 139-144 ◽

Cited By ~ 13

Author(s):

Monireh A Bani ◽

Mokhtar Arazpour ◽

Reza V Kashani ◽

Mohammad E Mousavi ◽

Maryam Maleki ◽

...

Keyword(s):

Grip Strength ◽

Hand Function ◽

Joint Stiffness ◽

Strength Loss ◽

Repeated Measure ◽

Pinch Strength ◽

Carpometacarpal Joint ◽

Custom Made ◽

First Carpometacarpal Joint ◽

Quasi Experimental

Background: Pain, reduced grip strength, loss of range of motion, and joint stiffness, leading to impaired hand function, and difficulty with daily activities are documented symptoms of first carpometacarpal joint osteoarthritis. Splinting is a common type of conservative treatment for this injury. Objectives: The aim of this study was to evaluate the effect of custom-made thumb splints on pain, function, grip strength, and key pinch in patients with first carpometacarpal joint osteoarthritis. Study Design: Quasi experimental. Methods: Patients with first carpometacarpal grade I and II osteoarthritis (n = 18) participated in a repeated measure study. The patients all wore custom-made thumb splints. All parameters were measured at baseline, and also after 30, 60, and 90 days from initial supply. A visual analogue scale, along with a disability of the arm, shoulder, and hand questionnaire, a dynamometer and pinch gauge were used to assess pain, function, grip strength, and pinch, respectively. Results: After 60 days of splint usage, grip strength was improved. However, a reduction in pain was demonstrated after only 30 days and this continued to improve with time. Function and pinch strength also increased significantly and continued to do so during the study period when compared to baseline. Conclusions: The use of a custom-made splint for patients with osteoarthritis of the first carpometacarpal joint produced decreased pain and increased grip strength, pinch strength, and hand function. Clinical relevance Custom-made splints may be recommended for the treatment of first carpometacarpal joint osteoarthritis.

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CORRELATION STUDY OF AGE WITH GRIP STRENGTH AND PINCH STRENGTH IN HEALTHY INDIVIDUALS

10.36106/gjra/3906362 ◽

2020 ◽

pp. 45-46

Author(s):

Divya Gupta ◽

Nisha Shokeen ◽

Sushmita Kushwaha ◽

Shilpa Shilpa

Keyword(s):

Grip Strength ◽

Hand Function ◽

Age Groups ◽

Correlation Study ◽

Upper Body ◽

Pinch Strength ◽

Age Group ◽

Healthy Individuals ◽

Strong Negative Correlation ◽

Age Related

Introduction: Deterioration in hand function in the elderly population is mostly secondary to age related degenerative changes in muscle, vascular and nervous system. Evaluation of hand strength can provide an objective index of general upper body strength. Aim: To determine the correlation of age with grip strength and pinch strength in healthy individuals. Methodology: This was a prospective study with 110 healthy subjects within the age group of 20-74 years. All the individuals in the study are divided in to 11 age groups of five years interval. Grip strength and pinch strength of each subject were recorded with hydraulic hand grip dynamometer and pinch gauge respectively. Then the data was calculated for further evaluations. Results: The highest and lowest grip as well as pinch strength was found in age group 30-34 year and 70-74 years respectively. The value of correlation coefficient, ‘r’ between age and grip strength was found to be -0.945 and between age and pinch strength was found to be -0.890 suggesting strong negative correlation of age with pinch and grip strength. Conclusion: The study concludes that with increasing age, grip strength and pinch strength decreases.

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Impairment Tutorial: Evaluating Impairment Due to Other Disorders of the Upper Extremity

Guides Newsletter ◽

10.1001/amaguidesnewsletters.1999.mayjun05 ◽

1999 ◽

Vol 4 (3) ◽

pp. 8-9

Author(s):

Robert Haralson ◽

Christopher R. Brigham

Keyword(s):

Grip Strength ◽

Hand Function ◽

Time Of Day ◽

Neurological Deficits ◽

Pinch Strength ◽

Standard Manner ◽

Normal Variance ◽

Highly Correlated ◽

Grip Strength Measurement ◽

Maximal Effort

Abstract Because grip and pinch strength are highly correlated and most literature deals with the former, this article focuses on grip strength, which is controversial because, as a functional test, it can be influenced by subjective factors that are difficult to control and include effort, pain, time of day, and fatigue. The AMA Guides to the Evaluation of Permanent Impairment (AMA Guides) identifies additional factors that influence grip and include sex, age, sensation, comorbidities, age, nutritional status, and, perhaps, handedness. Although grip strength is considered a measure of hand function, its correlation with activities of daily living is poor. Grip strength measurements must be performed in a standard manner because altering wrist, forearm, or elbow position can change the results. Impaired hand strength is compared to that of the opposite extremity, which usually is normal; if both extremities are involved, the strength measurements are compared to the average normal strengths. The AMA Guides specifies that grip measurements are regarded as reliable if there is less than 20% variation in the readings, but subjective factors may result in higher-than-normal variance between measurements of grip. Because pain interferes with maximal effort and, if present, may invalidate grip strength measurement, the latter generally is inappropriate to rate tendonitis or other painful conditions. Generally, grip strength is not used to rate neurological deficits.

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Multi-shot echo-planar diffusion tensor imaging in cervical spondylotic myelopathy

The Bone & Joint Journal ◽

10.1302/0301-620x.102b9.bjj-2020-0468.r1 ◽

2020 ◽

Vol 102-B (9) ◽

pp. 1210-1218

Author(s):

Hanwen Zhang ◽

Li Guan ◽

Yong Hai ◽

Yuzeng Liu ◽

Hongtao Ding ◽

...

Keyword(s):

Diffusion Tensor Imaging ◽

Clinical Outcomes ◽

Cervical Spondylotic Myelopathy ◽

Diffusion Tensor ◽

Neck Disability Index ◽

Cord Compression ◽

Functional Improvement ◽

High Signal ◽

Japanese Orthopedic Association ◽

Neck Disability

Aims The aim of this study was to use diffusion tensor imaging (DTI) to investigate changes in diffusion metrics in patients with cervical spondylotic myelopathy (CSM) up to five years after decompressive surgery. We correlated these changes with clinical outcomes as scored by the Modified Japanese Orthopedic Association (mJOA) method, Neck Disability Index (NDI), and Visual Analogue Scale (VAS). Methods We used multi-shot, high-resolution, diffusion tensor imaging (ms-DTI) in patients with cervical spondylotic myelopathy (CSM) to investigate the change in diffusion metrics and clinical outcomes up to five years after anterior cervical interbody discectomy and fusion (ACDF). High signal intensity was identified on T2-weighted imaging, along with DTI metrics such as fractional anisotropy (FA). MJOA, NDI, and VAS scores were also collected and compared at each follow-up point. Spearman correlations identified correspondence between FA and clinical outcome scores. Results Significant differences in mJOA scores and FA values were found between preoperative and postoperative timepoints up to two years after surgery. FA at the level of maximum cord compression (MCL) preoperatively was significantly correlated with the preoperative mJOA score. FA postoperatively was also significantly correlated with the postoperative mJOA score. There was no statistical relationship between NDI and mJOA or VAS. Conclusion ms-DTI can detect microstructural changes in affected cord segments and reflect functional improvement. Both FA values and mJOA scores showed maximum recovery two years after surgery. The DTI metrics are significantly associated with pre- and postoperative mJOA scores. DTI metrics are a more sensitive, timely, and quantifiable surrogate for evaluating patients with CSM and a potential quantifiable biomarker for spinal cord dysfunction. Cite this article: Bone Joint J 2020;102-B(9):1210–1218.

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The Effects of Latex Examination Gloves on Hand Function: A Pilot Study

Proceedings of the Human Factors and Ergonomics Society Annual Meeting ◽

10.1177/154193129503901009 ◽

1995 ◽

Vol 39 (10) ◽

pp. 582-585 ◽

Cited By ~ 2

Author(s):

Benny J. Moore ◽

Sudheer R. Solipuram ◽

Michael W. Riley

Keyword(s):

Grip Strength ◽

Occupational Safety ◽

Hand Function ◽

Manual Dexterity ◽

Pinch Strength ◽

Health Administration ◽

Power Grip ◽

Latex Glove ◽

Bare Hand ◽

Dental Professionals

Over the last decade the use of latex examination gloves by dental professionals has increased significantly. The proliferation in latex glove use is primarily due to recommendations and guidelines established by both the Centers far Disease Control and the Occupational Safety and Health Administration. Because a significant number of dental professionals are wearing latex examination gloves, it is important to understand the limitations and restrictions associated with wearing these gloves. This study investigated the effects of hand condition on three-jaw chuck pinch strength, power grip strength and manual dexterity. Hand condition consisted of three levels: (1) bare hand, (2) hand with a normal sized latex examination glove and (3) hand with a tight fitting latex examination glove. The results of the study indicated that latex examination gloves do not have an effect on three-jaw chuck pinch strength or power grip strength. However the study suggested that ill-fitting latex examination gloves significantly reduce manual dexterity.

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The results of surgical treatment for cervical spondylotic myelopathy

Acta chirurgica iugoslavica ◽

10.2298/aci0501091r ◽

2005 ◽

Vol 52 (1) ◽

pp. 91-95 ◽

Cited By ~ 1

Author(s):

Danilo Radulovic ◽

S. Ivanovic ◽

M. Jokovic ◽

G. Tasic

Keyword(s):

Surgical Treatment ◽

Cervical Spondylotic Myelopathy ◽

Intervertebral Disc Degeneration ◽

Functional Results ◽

Surgical Decompression ◽

Grading System ◽

Operative Complications ◽

Postoperative Improvement ◽

Selection Of

Objective: Cervical spondylotic myelopathy is the most serious consequence of cervical intervertebral disc degeneration. The purpose of this study is to evaluate functional results of surgical treatment of patients with cervical spondylotic myelopathy who underwent anterior or posterior decompressive operations. Methods: we prospectively analyzed 57 patients with cervical spondylotic myelopathy who were operated in Institute for Neurosurgery in Belgrade (1995-2002). The severity of myelopathy is graded by Nurick myelopathy grading system. The average follow-up period was 20 months. Results: Postoperative improvement showed 75% of patients and 21% remained unchanged. Myelopathy worsening was observed in two patients, 4%. We didn't have serious operative complications. Selection of surgical approach was not significantly correlated with surgical outcome. Conclusion: surgical decompression of cervical medulla is safe treatment that gives good chances for functional recovery in patients with cervical spondylotic myelopathy.

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Comparison of impairment and restitution of hand function in a group of patients with total damage to the extensor pollicis longus and in a group of patients with damage to the flexor pollicis longus tendon after surgical treatment

Rehabilitacja Medyczna ◽

10.5604/01.3001.0009.5009 ◽

2016 ◽

Vol 20 (3) ◽

pp. 5-12

Author(s):

Jakub Szczechowicz ◽

Krzysztof Jamka ◽

Marek Pieniążek

Keyword(s):

Surgical Treatment ◽

Physical Therapy ◽

Muscle Strength ◽

Hand Function ◽

Functional Improvement ◽

Study Group ◽

Flexor Pollicis Longus ◽

Extensor Pollicis Longus ◽

Flexor Pollicis Longus Tendon ◽

Total Damage

The thumb constitutes 40% of the whole hand function, and damage to the extensor pollicis longus (EPL) and/or the flexor pollicis longus (FPL) tendons of the thumb results in its significant limitation. The main factors contributing to damage of the EPL and/or FPL tendons are mechanical injuries - cuts and spontaneous ruptures. The aim of the study was to compare values of thumb and whole hand function loss and restoration as a result of the implemented physical therapy in patients with total damage to the EPL tendon with the values obtained by the study group 2 comprised of patients with damage to the FPL tendon. The study involved 25 patients of the Specialized Hand Therapy Center in Krakow. 15 of them had ruptured continuity of the EPL tendon (study group), and 10 suffered damage to the FPL tendons (control group). The study included measurements of active motion of the thumb and wrist and superficial sensation. On the basis of these tests, functional impairment was measured using the methodology according to Swanson. The study included assessment of muscle strength in terms of global and precision grips using a dynamometer. Statistically signifcant functional improvement was noted for the thumb and whole hand as well as muscle strength in both groups. The values of functional loss differed between the two groups. The indicators of functional improvement were greater in patients with damage to the EPL tendon. Functional physical therapy is an important factor determining the return of function in the thumb and whole hand after total damage to the EPL and FPL tendons. Szczechowicz J., Jamka K., Pieniążek M. Comparison of impairment and restitution of hand function in a group of patients with total damage to the extensor pollicis longus and in a group of patients with damage to the flexor pollicis longus tendon after surgical treatment. Med Rehabil 2016; 20(3): 5-12. DOI: 10.5604/01.3001.0009.5009

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