Muscle strength measurements of the Hand - Handen Team Zeeland

Ton A.R. Schreuders, JW Brandsma, HJ Stam
In patients in whom the ulnar nerve
is paralysed a Wartenberg sign can be
seen, which is usually described as a sign
FIGURE 8. Loss of the metacarpal arch in a
patient three months after ulnar nerve injury in
right hand.
of activity of long extensor tendons
of the little finger running radially of the
MCP joint. The extensors produce an
abduction force on the little finger which is
not opposed by the paralysed intrinsic
muscles. 80 In hands in which the ulnar
nerve innervated muscles are recovering,
the abducted position of the little finger
often increases. In this situation we think it
is also a sign of poor recovery of the third
palmar interosseous muscle, in which the
disbalance between the intrinsic abductors
and adductors may cause an abducted
little finger.
3.3 Assessment possibilities (manual and
instrumental)
Due to the superficial location, the
hypothenar muscles can be well observed
and palpated during MMST. 53 This test is
very useful to assess the recovery of the
ulnar nerve function. 53 When testing the
abduction of the little finger the ADM and
FDM are tested. In the intrinsic plus
position, pressing against the volar side of
the PIP of the 5 th finger, the same muscles
can be tested as a group. ODM is tested in
the cupping of the hand, when flexion of
the CMC of the 5 th ray is tested.
Instrumented measurements of the
abduction strength of the 5 th finger are
possible with dynamometers such as the
RIHM and Mannerfelt’s Intrins-o-meter.
3.4 Therapy principles (prevention
complications, strengthening)
Similar training activities as
described for the interossei can be
recommended. Grasping round objects
emphasising the cupping of the hand is
specifically trained, and specific attention
is given to the shaping of the arch of the
hand in grasping large objects and
handles.
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