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The purpose of this study was to assess whether there is a universal pattern of movement of the finger joints while performing a cylinder grip. A sensor glove was used to record the finger joint motion of 48 participants. Our observations showed that when examining the fingers, flexion motion began either at the metacarpophalangeal (MP) or proximal interphalangeal (PIP) joints, with the distal interphalangeal (DIP) joints always last to move (p = 0.0052). The sequence of the joints at the end of the gripping motion was different than at the beginning. Here, the only statistically significant observation was that the DIP joints fully flexed only once the MP joints had flexed fully. Apart from that, it was completely variable which joint reached its final position first or last. The analysis also revealed that synchronization of four identical joints (i.e. the four PIP joints) was significantly higher than synchronization of the 12 finger joints. Although synchronization was already high at the beginning of the flexion motion, it increased significantly by the time the joints completed their movement. [ABSTRACT FROM PUBLISHER]

Study Design: A within-subject research design was used in this study. The difference of the range of motion (ROM) with and without ulnar nerve block was analyzed., Introduction: For the clinical evaluation of the functional effects of ulnar nerve palsy at the hand the relevance of clinical tests is in discussion., Purpose of the Study: The aim of the study was to evaluate the predictive value of 2 clinical tests for a simulated ulnar nerve lesion by motion analysis with a sensor glove., Methods: In 28 healthy subjects, dynamic measurements of the finger joints were performed by a sensor glove with and without ulnar nerve block at the wrist. In the 0° metacarpophalangeal (MCP) stabilization test, the subjects were asked to stabilize the MCP joints actively in 0° while moving the interphalangeal joints, whereas at the 90° MCP stabilization test, the subjects stabilized the MCP joints actively in the 90° position., Results: In the 0° MCP stabilization test, no remarkable changes of the ROM were found at the MCP joints; at the proximal interphalangeal joints 2-5, the ROM decreased with ulnar nerve block, significantly at the index, middle, and ring fingers (P < .05). In the 90° MCP stabilization test, the average ROM of the MCP joints 2-5 significantly increased with ulnar nerve block (P < .05), whereas at the PIP joints, the average ROM decreased (P < .05)., Discussion: The 90° MCP stabilization test had a high predictive value for the discrimination between healthy subjects and subjects with a simulated peripheral ulnar nerve lesion., Conclusions: The results could be relevant for the determination of the functional effect of ulnar nerve palsy and the quantification of clawing in hand rehabilitation., Level of Evidence: II., (Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Introduction: In the assessment of hand and upper limb function, grip strength is of the major importance. The measurement by dynamometers has been established., Purpose of the Study: In this study, the effect of a simulated ulnar nerve lesion on different grip force measurements was evaluated., Methods: In 25 healthy volunteers, grip force measurement was done by the JAMAR dynamometer (Fabrication Enterprises Inc, Irvington, NY) for power grip and by a pinch strength dynamometer for tip pinch strength, tripod grip, and key pinch strength., Study Design: A within-subject research design was used in this prospective study. Each subject served as the control by preinjection measurements of grip and pinch strength. Subsequent measurements after ulnar nerve block were used to examine within-subject change., Results: In power grip, there was a significant reduction of maximum grip force of 26.9% with ulnar nerve block compared with grip force without block (P < .0001). Larger reductions in pinch strength were observed with block: 57.5% in tip pinch strength (P < .0001), 61.0% in tripod grip (P < .0001), and 58.3% in key pinch strength (P < .0001)., Discussion: The effect of the distal ulnar nerve block on grip and pinch force could be confirmed. However, the assessment of other dimensions of hand strength as tip pinch, tripod pinch and key pinch had more relevance in demonstrating hand strength changes resulting from an distal ulnar nerve lesion., Conclusions: The measurement of tip pinch, tripod grip and key pinch can improve the follow-up in hand rehabilitation., Level of Evidence: II., (Copyright © 2017 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.)

Background: These days there are different types of aftercare following flexor tendon injury. Patients in this study received a dynamic Kleinert protocol and additionally two different postoperative treatments. Both treatment groups were compared to each other and results were put into perspective when compared to other treatment options., Methods: Sixty-two patients presenting with clean lesions of the two flexor tendons in zone 2 received postoperative treatment with a dynamic Kleinert protocol. Patients were randomly divided into either Group I (physical therapy) or Group II (exoskeleton). Range of motion was assessed after 6, 12 and 18 weeks. In addition, we measured the Strickland score and grip strength at the 18-week follow-up. DASH scores were obtained at weeks 12 and 18., Results: Regardless of the received postoperative treatment, range of motion was predominantly limited in the proximal interphalangeal and distal interphalangeal joints after 6 weeks. This deficit decreased with time and almost full range of motion was achieved after 18 weeks. Grip strength measured 75% (Group I) and 78% (Group II) of the healthy hand's level. Good functional outcome was observed in the DASH scores after 12 weeks, which improved further, measuring 7.5 (Group I) and 6.8 (Group II) at the 18-week follow-up. We did not see any clinically relevant differences between the two patient groups., Conclusion: Regarding possible reruptures, the Kleinert protocol delivers a safe treatment regime. The possible disadvantage of flexion contractures with the Kleinert protocol was not seen in our measurements. Additional motion exercises using an exoskeleton delivered comparable results to classic physical therapy.

Background: Peripheral lesions of the median nerve cause characteristic changes of the grip function of the hand. For evaluating grip force changes, measurement by dynamometers (JAMAR dynamometer and pinch dynamometer) is of high relevance. In this study the ability of grip force measurements of different grip forms was evaluated to discriminate between a simulated median nerve lesion and healthy subjects., Material and Methods: In 21 healthy subjects, the grip force of power grip was measured by the JAMAR dynamometer at the second stage including measurement of force at the fingertips and the thenar by a sensor glove. With a pinch dynamometer the power of palmar abduction, precision grip, pincer grip and pinch grip was determined. Measurements were performed with and without median nerve block at the wrist., Results: In power grip of the JAMAR dynamometer at the second stage a significant reduction of the grip force of 13.4% was found (p < 0.03). The power distribution between the fingers D2-D5 did not change with median nerve block. The most relevant reduction of grip force in median nerve block compared with the healthy control was measured in palmar abduction (72.1%, p < 0.0002), followed by precision grip 31.0% (p < 0.0001), pincer grip 23.6% (p < 0.0004) and pinch grip 18.8% (p < 0.0002)., Conclusions: For the discrimination between healthy subjects and subjects with a median nerve block there was a limited relevance of the measurement of the power grip and force distribution at the fingers by the JAMAR dynamometer. However, the best distinction was observed by dynamometric measurement of other grips than power grip, such as palmar abduction, precision grip, pincer grip and pinch grip. The results could be relevant for the clinical diagnostics and rehabilitation of median nerve lesion, complementing the widespread measurement of the power grip by other grip forms.