Hand Strengthening

Strengthening protocols are initiated following healing of the wound and any repaired structures as well as successful pain control. The goals of strengthening include improved grip, tip pinch, key pinch, and function. Older patients with decreased grip strength (<40 lb) report dissatisfaction with health-related quality of life and function compared with patients with better grip strength (>60 lb). This reduction in grip strength may be linked to sarcopenia and generalized frailty, which is common in older patients. For patients with sarcopenia, therapeutic interventions that improve muscle mass and strength may prevent the onset of chronic disorders that negatively affect health-related quality of life.

The scope of a strengthening program depends on the nature of the injury, status of the soft tissue, level of pain, and biomechanics of the fracture fixation and/or soft-tissue repair. Strengthening protocols are graduated, with progressive loading and resistance; both eccentric and concentric muscle contractions are used. Strengthening or maintenance of muscle tone is incorporated into most active-motion protocols. Increasing muscle strength often improves ROM, facilitates lysis of adhesions, and improves excursion. Neuromuscular electrical stimulation can be used for patients who are unable to initiate muscle contractions to generate sufficient force. Exercises that incorporate functional activities of daily living have been shown to improve ROM and strength generation in young patients after hand injury.

The Jamar Hand Dynamometer (Asimow Engineering, Los Angeles, CA) is the most commonly used instrument to measure grip strength. Multiple studies have confirmed its validity and reproducibility. Repeated measurements of grip, key pinch, and tip pinch provide objective measures of improvement in both strength and function