Bedside Hand Grip Assessment with the Sphygmomanometer
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University of Alabama at Birmingham, Birmingham, AL, USA; 2Tinsley Harrison Internal Medicine Residency Program, University of Alabama at Birmingham, Birmingham, AL, USA; 3Veterans Affairs Quality Scholars Program, Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA; 4Division of General Internal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
KEY WORDS: physical examination; hand Strength; muscle strength dynamometer. J Gen Intern Med DOI: 10.1007/s11606-013-2426-0 © Society of General Internal Medicine 2013
39-year-old, right-handed man presented with rapidly A progressive weakness of his dominant hand. On examination, his grip strength was normal in the left hand and decreased in the right (Fig. 1). He was found to have a leftsided brain tumor, which was thought to explain his weakness. Routine bedside assessment of grip may not detect subtle changes in strength. Using the sphygmomanometer, clinicians can measure grip strength at the bedside more objectively1 (Fig. 2). First, the sphygmomanometer is rolled into a cylinder comfortable for the patient to grip at rest. The cuff is then inflated to 20 mmHg, and the patient applies maximal grip force to the cuff. The gauge needle indicates the patient’s applied pressure (left hand, about 250 mmHg). In this case, his right hand grip was decreased (right hand, about 110 mmHg). See the online video appendix demonstrating the technique.
Figure 2. Hand grip assessment using sphygmomanometer.
This convenient bedside measurement technique has been used in the past to measure grip strength in patients with rheumatoid arthritis, and has been shown to be reliable when compared to the Jamar dynamometer (the reference standard for testing grip strength).1,2 Clinicians should be aware of this method when assessing subtle changes of grip strength.
Conflict of Interest: The authors declare that they do not have a conflict of interest. Funding and Support: None. Disclaimer: The opinions expressed in this article are those of the authors alone and do not reflect the views of the Department of Veterans Affairs.
Figure 1. Hand grip assessment using index card.
Electronic supplementary material The online version of this article (doi:10.1007/s11606-013-2426-0) contains supplementary material, which is available to authorized users. Received August 12, 2012 Revised November 27, 2012 Accepted January 4, 2013
Corresponding Author: Carlos A. Estrada, MD, MS; Division of General Internal Medicine, University of Alabama at Birmingham, 732 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294-3407, USA (e-mail: [email protected]).
REFERENCES 1. Hamilton GF, McDonald C, Chenier TC. Measurement of grip strength: validity and reliability of the sphygmomanometer and Jamar grip dynamometer. J Orthop Sports Phys Ther. 1992;16:215–219. 2. Lansbury J. Numerical method of evaluating the status of rheumatoid arthritis. Ann Rheum Dis. 1957;17:101–107.
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