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Inconsistent findings of a proximity effect of sucrose on muscular strength and a potential interaction of nutritional status prompted the current study. Double-blind, counterbalanced assessments of grip strength were performed with and without 76 subjects holding a container of sucrose. No main effect was found for proximity of glucose, and no interaction was found for prandial status.
This is a review of 20 patients (22 operations) with symptomatic osteoarthritis of the first carpometacarpal joint who were treated by simple trapezectomy without interposition material. They were all women with a mean age of 60 years (46-77). The average follow-up was 2 years, ranging from 8 months to 3 years. Pain relief is the main contributor to the good clinical results of this procedure. Sixteen patients professed to be very satisfied, two had a fair result and four cases claimed to be unsatisfied. Range of motion (opposition and counter opposition) and first web space were very well preserved. Mean values of grip strength showed reduction of grip power on the operated side though not statistically. However, we did find a statistically significant difference in pinch strength between operated and non-operated side. In general, simple trapezectomy is our preferred surgical therapy in the treatment of carpometacarpal osteoarthritis in the elderly population.
Avulsion fractures of the metacarpophalangeal joints are uncommon and there are few reports on their outcome after conservative treatment. We treated seven such patients with fracture fragment sizes between 10% and 25% of the width of the articular surface on the radiograph by early active mobilisation in neighbour strapping. The outcome of treatment was assessed at a mean follow-up of 57 (range 8-94) months. The mean visual analogue pain score was 0.6 (range 0-2) and the mean visual analogue function score was 9 out of 10 (range 6-10). The mean DASH score was 3.1 (range 0-12.5). All but one patient had normal grip strength and a full range of finger movement. We believe that the majority of avulsion fractures of the metacarpophalangeal joint can be managed successfully without surgery.
In this study we examined the effects of insulin-like growth factor-I (IGF-I) and of glycosaminoglycans (GAGs) on the progressive motor neuron disease in wobbler mice. After clinical diagnosis at age 3 weeks, mice received daily subcutaneous injections of IGF-I, or GAGs, or saline for 3 weeks. The histometric analysis revealed that biceps muscle fiber diameter was reduced in wobbler mice and that treatments with GAGs and IGF-I prevented such a drop. The number of atrophic small fibers was markedly reduced and that of the larger ones augmented. No effects on body growth and biceps muscle weight were observed. The combined AChE-silver staining revealed that both treatments promoted intramuscular axonal sprouting. The typical decline of grip strength in wobbler mice was also prevented. This study suggests that GAGs and IGF-I administrations can retard the onset of motor deficit, and reduce muscle atrophy in wobbler mice.
The goal of this anatomical study is to prove that reconstruction of the flexor retinaculum in carpal tunnel syndrome surgery is a reliable procedure and can improve the results of this procedure. In the first static study, we noted that when left to heal spontaneously, after 3 months the gap between the two edges of the cut retinaculum remained equal to or even larger than the gap created at the time of the surgery. A special Canaletto implant was created to achieve this reconstruction. It is technically possible to do this reconstruction by a 2 to 3 cm surgical approach in the palm. In another, dynamic study, we used a transducer to analyse the forces borne by the retinaculum during flexor tendon contraction. We compared these forces in a normal retinaculum, a reconstructed retinaculum with the Canaletto implant and a retinaculum opened endoscopically. This reconstruction conserves the anterior continuity of the retinaculum, allows excellent carpal tunnel decompression and immediately permits near-physiological forces. We discuss the advantages and the limits of this reconstruction. We think that this new surgical technique in the Carpal Tunnel Syndrome (CTS) will be able to improve the results, particularly in recurrences, in wrist malunion with CTS, in cases with severe electromyographic change with a sensory conduction speed of under 15 m.s-1 and in metabolic CTS. As always, his implant needs to be evaluated through a mid and long term clinical follow-up. By recovering better grip strength and reducing postoperative pain, this surgical technique can decrease the time needed to return to work and hence the economic costs of CTS surgery.
A prospective consecutive series of 20 proximal interphalangeal (PIP) joints replaced with a new ceramic unconstrained prosthesis (MOJE) included 13 patients with osteoarthrosis, five with rheumatoid arthritis, and one each with post-traumatic infection and traumatic arthrosis. All patients were assessed preoperatively and postoperatively at one year by an independent physiotherapist and an occupational therapist who evaluated grip strength, range of motion, activities of daily living (ADL) and occupational scores (COPM Canadian Occupational Performance Measure). The mean range of motion of the PIP joint improved from 43 degrees to 60 degrees (p=0.001), and the mean grip strength from 169-199 N (p=0.002). The patients' self-perception of occupational performance, assessed by the COPM, improved significantly from 3.6-6.6 (p<0.001) for satisfaction, and 3.8-6.3 (p<0.001) for performance. The MOJE PIP joint replacement provides significant pain relief, improved strength and range of motion, and short-term satisfaction. Further long-term studies are therefore advocated.
The results concerning morbidity of the fasciocutaneous radial forearm flap donor site of 20 patients are presented. The review was carried out with an average time of 4.4 years after raising the flaps, ranging from ten months to eleven years. Range of motion of the wrist joint was limited in extension in two patients with 15 degrees and in one patient with 30 degrees. Pinch and grip strength was found normal in 13 patients and was limited in five cases to 88% of the strength of the opposite limb. Dysesthetic areas were found in three patients on the radial border of the donor site and reduced sensation of the radial nerve was present in four patients.
OBJECTIVE: To assess and compare the suitability of Moberg pickup test (MPUT) and button test (BT) as indicators for functional impairment in patients with inflammatory joint diseases. METHODS: Measurements for 369 patients attending a rheumatology outpatient clinic were collected. In addition to MPUT and BT, measurements collected were grip strength, tender and swollen joint counts, visual analog scales for pain and disease activity, Health Assessment Questionnaire, C-reactive protein levels, and erythrocyte sedimentation rates. RESULTS: We found a significant relationship between MPUT and BT. Both tests show the same pattern of correlations with the other parameters, although all correlations are higher for MPUT. There is a significant sex and learning effect for the BT, which implies a confounding of hand function and motor abilities. A significantly higher proportion of patients was unable to complete BT. CONCLUSION: MPUT and BT measure comparable aspects of hand function. In several theoretical and practical aspects, MPUT seems superior to BT in arthritis. It is necessary to evaluate its value in long-term followup.
Seven subjects were asked to reach and grasp an object between the thumb and index finger, lift it about 30 cm high and 25 cm forward from one table to another, at their preferred speed. The perpendicular grip force and the tangential load force applied to the contact surface were digitized at 500 Hz and stored on a laboratory computer. The trajectory of the wrist and of the object was recorded using four infrared cameras tracking the movement of reflective markers attached to the distal styloid process of the radius and on the top of the object. The aim of this study was to demonstrate the influence of low friction (i.e. surface slipperiness) on the acceleration of the wrist. Friction was reduced by coating the smooth brass grasping surface with talc. The seven subjects had skin to surface coefficients of friction which ranged from 0.52-1.18 for dry brass and 0.24 0.34 for talc-coated brass. Two weights (418 and 1070 g) were used with each surface. The results indicated that with the slippery surface the necessary higher grip force/load force ratio was produced by an increase in the grip force and by a decrease in the wrist acceleration and a consequent reduction in the load force. This strategy was observed for both weights over a range of grip strengths between 21-98% of the individual's maximum voluntary contraction (MVC). This implies that even with adequate grip force reserves the reduction in acceleration is an acceptable and probable alternative solution to the force control problem. Our results also suggested that the loading rate and the object acceleration were planned and controlled together which emphasizes the role played by a predictive mechanism in organizing the kinematics of movements involving hand-held objects. This study shows that friction of the grasping surface not only affects the prehensile force dynamics, but it also influences the kinematics of the entire upper limb.
The literature unequivocally supports the LRTI arthroplasty. Indeed, thumb stability, pain relief, and improvements in strength are the expected outcomes. Although some investigators believe that ligament reconstruction is not necessary, trapezium excision alone, or in combination with facial or tendon interposition, is less likely to provide long-term stability or restore satisfactory pinch and grip strength. Some hand surgeons may be apprehensive about harvesting the entire width of the FCR tendon because of fear that wrist function may be impaired or that a larger bony channel in the metacarpal might result in fracture. In that light, Coleman and the author recently reported the results of a prospective evaluation that rather convincingly showed there was no morbidity accompanying harvest of the entire FCR tendon, from the standpoint of wrist strength or endurance. Furthermore, technical modification by which the end of the FCR is tapered or trimmed obviates the need for an excessively large bony channel through the metacarpal. Preliminary pin fixation of the metacarpal, with its base suspended at the level of the index CMC joint, in the fisted position, is still recommended to allow accurate tensioning of the new ligament, and protection in the early postoperative period. Proximal migration of only 13% at an average of 9 years after surgery may very well reflect the value of this particular practice. In conclusion, attention to technical detail and compliance with the postoperative therapy program, in the author's opinion, are intricately related to the favorable outcomes he has observed during 5 years of seeing Burton perform the LRTI arthroplasty and more than 6 years of performing the procedure in his own practice.
Forty-eight community living women 66-87 years old volunteered to participate in a 12-month prospective, randomized, controlled, trial. The aim was to determine if a combined weight-bearing training program twice a week would be beneficial to bone mineral density and neuromuscular function. The participants were pairwise age-matched and randomly assigned to either an exercise group (n=24) or a control group (n=24). Twenty-one subjects in the intervention group and 19 in the control group completed the study. The exercise program lasted for 50 min and consisted of a combination of strengthening, aerobic, balance and coordination exercises. The mean percentage of scheduled sessions attended for the exercise group was 67%. At the completion of the study, the intervention group showed significant increments in bone mineral density of the Ward's triangle (8.4%, P<0.01) as well as improvement in maximum walking speed (11.4%, P<0.001) and isometric grip strength (9.9%, P<0.05), as compared to the control group. The conclusion was that a combined weight-bearing training program might reduce fracture risk factors by improving bone density as well as muscle strength and walking ability. This program could be suitable for older community living women in general, and might, therefore, have important implications for fracture prevention.
The benefit of impact-loading activity for bone strength depends on whether the additional bone mineral content (BMC) accrued at loaded sites is due to an increased bone size, volumetric bone mineral density (vBMD) or both. Using magnetic resonance imaging (MRI) and dual energy X-ray absorptiometry (DXA), the aim of this study was to characterize the geometric changes of the dominant radius in response to long-term tennis playing and to assess the influence of muscle forces on bone tissue by investigating the muscle-bone relationship. Twenty tennis players (10 men and 10 women, mean age: 23.1+/-4.7 years, with 14.3+/-3.4 years of playing) were recruited. The total bone volume, cortical volume, sub-cortical volume and muscle volume were measured at both distal radii by MRI. BMC was assessed by DXA and was divided by the total bone volume to derive vBMD. Grip strength was evaluated with a dynamometer. Significant side-to-side differences (P<0.0001) were found in muscle volume (+9.7%), grip strength (+13.3%), BMC (+13.5%), total bone volume (+10.3%) and sub-cortical volume (+20.6%), but not in cortical volume (+2.6%, ns). The asymmetry in total bone volume explained 75% of the variance in BMC asymmetry (P<0.0001). vBMD was slightly higher on the dominant side (+3.3%, P<0.05). Grip strength and muscle volume correlated with all bone variables (except vBMD) on both sides (r=0.48-0.86, P<0.05-0.0001) but the asymmetries in muscle parameters did not correlate with those in bone parameters. After adjustment for muscle volume or grip strength, BMC was still greater on the dominant side. This study showed that the greater BMC induced by long-term tennis playing at the dominant radius was associated to a marked increase in bone size and a slight improvement in volumetric BMD, thereby improving bone strength. In addition to the muscle contractions, other mechanical stimuli seemed to exert a direct effect on bone tissue, contributing to the specific bone response to tennis playing.
OBJECTIVES: There are conflicting data in the literature whether estrogens affect muscle strength. Prospective studies with hormone replacement therapy have not been able to convincingly demonstrate a muscular effect and the putative role of estrogen in the development of lean body mass is not established. Both lean mass and fat mass are known to be under strong genetic control and therefore we have investigated the relation between a TA-repeat in the gene for the estrogen receptor alpha (ERalpha) and muscle strength and body composition. METHODS: 175 healthy Swedish women, aged 20-39 were randomly selected from the population registry and included in the study. Body mass measurements (lean mass, fat mass, body weight and BMI) and muscle strength (quadriceps, hamstring and grip strength) were evaluated. The TA-repeat in the ERalpha gene was amplified by polymerase chain reaction. RESULTS: Alleles with a TA-repeat length of 16 repeats or shorter were denoted short (e), and repeat length of 17 repeats or longer were denoted long (E). Women homozygous for the short and long genotype were denoted ee (31%) and EE (21%), respectively, while heterozygous individuals were denoted Ee (48%). The frequencies were in Hardy-Weinberg equilibrium. No associations were found between ERalpha genotypes and muscle strength or body composition. CONCLUSION: The TA-repeat in the human ERalpha gene does not correlate with muscle strength or body mass measurements, indicating that body composition is not as sensitive to genetic variation in this receptor as other target organs for estrogen.
The rodent grip strength test was developed decades ago and is a putative measure of muscular strength. This test has been included in the functional observational battery (FOB) to screen for neurobehavioral toxicity, and changes in grip strength have been interpreted as evidence of motor neurotoxicity. Despite its widespread use, questions remain about what the grip strength test actually measures. In this study, potential confounders of the grip strength test were identified and tested, including operational parameters, disruption of peripheral sensory function and changes in body weight. Operational parameters (sampling rate, system type and trial angle but not trial speed) had dramatic effects on grip strength data. Doxorubicin (DX, 10 mg/kg iv) was used to cause sensory impairment. It decreased forelimb and hindlimb grip strength (by 27% and 32%, respectively, compared with controls), an effect that was correlated with degeneration of peripheral and central sensory components (distal tibial and sural nerves, dorsal funiculus of the spinal cord and dorsal, but not ventral, spinal roots). Feed restriction-induced loss of body weight (26% compared with controls) and muscle mass (20% compared with controls) reversibly decreased both forelimb and hindlimb grip strength (18% and 17%, respectively, compared with controls). Ignoring these confounding factors could potentially lead to increased data variability and inconsistency within single studies, across studies and in historical control data sets. To assist in data interpretation and evaluation of grip strength results, it is suggested that exact conditions of application of the test be reported in greater detail. Furthermore, given that the grip strength test can be influenced by factors other than true muscular strength, use of the term grip performance is proposed to better reflect the apical nature of this test.
OBJECTIVE: We modified existing standardized measurement tools in the Physical Performance Test and tasks from the Frailty and Injuries: Cooperative Studies of Intervention Technique Study to evaluate physical function in older women. Our objectives were (1) to characterize physical function themes based on combinations of tasks (deriving factors or components) and (2) to quantify the correlation between derived factors and body mass index (BMI). RESEARCH METHODS AND PROCEDURES: Nutrition risk screens from enrollees in a Medicare-managed risk program served as the sampling frame. To obtain adequate representation for a range of BMI, a random sample was obtained of 90 women from the following BMI strata: BMI, 22 to <27 kg/m(2); BMI, 27 to <30 kg/m(2); and BMI, > or =30 kg/m(2). Subjects were asked to perform a series of 18 functional tasks during a home visit. RESULTS: The mean age was similar in the three BMI groups with an overall mean age of 71 +/- 4.9 years (SD). Factors characterized by lower-body function, upper-body function, coordination, and strength were responsible for 30%, 11%, 9%, and 9% of the variance in task scores, respectively. BMI, controlling for age, explained 5%, 14%, 3%, and 0% of the variation in these factors, respectively. Higher BMI is associated significantly with poorer upper- and lower-body function but is not associated significantly to strength or coordination. DISCUSSION: Higher BMI seems to differentially impede specific aspects of physical function, especially upper-body function, and to a lesser extent, lower-body function. BMI does not seem to be associated with levels of coordination or strength. Better understanding of how BMI impacts physical function will aid in the design of interventions to promote independent living in elderly, obese women.
This study was conducted to test the hypothesis that inhibitory reflexes from respiratory centres in the brain or respiratory muscles limit the central motor drive to limb muscles during exhaustive exercise in chronic hypoxia. Experiments were performed on five members of an expedition to the Himalayas, following 56-81 days at altitudes of 5200-7500 m. During the last minute of exhaustive maximal two-legged cycling with and without 4% CO2 inhalation performed on different days, repeated maximal voluntary handgrip contractions (MVC) over 60 s (5 s contraction, 5 s rest; x 6) were performed at rest and exhaustive exercise MVC or rate of decay of MVC was unaffected by simultaneous engagement of a major fraction of the muscle mass (leg muscles) and a very high pulmonary ventilation. With 4% CO2, peak pulmonary ventilation during the exhaustive exercise increased further by 41 L min-1 (140-181 L min-1; P < 0.05) without affecting the handgrip strength. These findings suggest that during exhaustive exercise of large muscle groups in chronic hypoxia, both maximal voluntary contraction force and dynamic muscle contractile force are not limited by extreme activation of respiratory centres or muscles.
OBJECTIVE: To assess age and gender differences in muscle strength. DESIGN: The strength of back extensors, upper limbs (grip), and lower limbs (knee extensors) was measured. Anthropometric measurements and body mass index also were assessed. RESULTS: Group comparisons were made for each decade. Back extensor strength (BES) in subjects aged 20 to 89 yr ranged from 93 to 832 N in men and from 71 to 440 N in women. BES peaked in the fourth decade for men and in the fifth decade for women. When the two genders were compared, muscle strength in women was less than that in men at all ages. At different decades, women's BES ranged from 54% to 76% compared with that of men's BES. There was a 64% loss of BES in men from the peak in their fourth decade (556 N) to the lowest level in their ninth decade (201 N). Women experienced a 50.4% loss from the peak in their fifth decade (306 N) to the lowest level in their ninth decade (152 N). CONCLUSIONS: Men had a greater loss of BES than women with increasing age. In both genders, there was more loss of BES than appendicular muscle strength. Reduction in BES in women coincided with increased body mass index in older age. In women, there was a negative correlation between body weight and level of physical activity, whereas this finding was not evident in men. Background factors related to a higher incidence of back pain, falls, and fractures, especially in women, may be a reduction in muscle strength, along with increasing age and body mass index. This cross-sectional study showed that physiologic reduction of muscle strength, which began early in life, later stopped and that muscle strength even improved, despite the aging process. Therefore, initiating strengthening exercises at any age is encouraged to prevent the impact of several age-related musculoskeletal challenges.
In a study on 14 healthy children aged from 6 to 13 years, the volumetric spongiosa bone density (SBD), cortical bone density (CBD), bone cross-sectional area (BCSA), cortical area (CA), and bone strength index (BSI) at the distal radius were analyzed using peripheral quantitative computer tomography (pQCT Bone Scanner XCT-900, Stratec, Pforzheim, Germany). BSI values were calculated on the basis of the moment of resistance and cortical density using system integrated software. These parameters were correlated with grip strength measurements obtained using a grip dynamometer. There were age-dependent increases in BCSA (r = 0.68), CA (r = 0.78), BSI (r = 0.79). SBD and CBD, however, did not show an increase with age. Grip strength correlates strongly with the parameters of bone geometry BCSA (r = 0.8), CA (r = 0.86), and BSI (r = 0.9) at p < 0.01. SBD and CBD showed no significant correlation to grip strength. The results of this study suggest that an increase in cortical thickness and cross-sectional area represent the most important adaptation mechanisms of the growing bones in response to biomechanical usage. These parameters represent the most important factors of bone strength. Volumetric bone density (material characteristic) of spongiosa and cortical bone is an age-independent parameter which does not change significantly with increasing muscular strength in healthy subjects. These relationships must be considered when selecting parameters to be used as success criteria in studies on the influence of physical exercise on bone status.