You are on page 1of 6
Grip and Pinch Strength: Normative Data for Adults Virgil Mathiowetz, MS, OTR, Nancy Kashman, OTR, Gloria Volland, OTR, Karen Weber, OTR, Mary Dowe, OTS, Sandra Rogers, OTS Oceupanional Therapy Program. University of Wisconsin-Milwavkee, Milwaukee, WI $3201 ABSTRACT. Mathiowetz V, Kashman N, Volland G. Weber K, normative dita for adults. Arch Phys Med Rehabil 66:69-72, 1985. ‘© The primary purpose of this study was to establis of hand strength. A dynamometer was used to measure grip strength and a pinch gauge to 1 Dowe M, Rogers S: Grip and pinch strength: ‘clinical norms for adults aged 20 to 75+ years on four tests sure tip, key, and palmar pinch. A sample of 310 male and 328 female adults, ages 20 to 94, from the seven-county Milwaukee area ‘were tested using standardized positioning and instructions. Right hand and left hand data were stratified into 12 ‘age groups for both sexes. This stratification provides a means of comparing the score of individual patients to that ‘of normal subjects of the same age and sex. The highest grip strength scores occurred in the 25 to 39 age groups. For tip, key, and palmar pinch the average scores were relatively stable from 20 to $9 years, with a gradual decline from 60 to 79 years. A high correlation was seen between grip strength and age, but a low between pinch strength and age. The newer pinch gauge used in this study appears to read hi jrmative study. Comparison ofthe average hand strength of right-handed and left-handed subjects showed a previous: only minimal differences. noderate correlation KEY WORDS: Exercise test: Exertion: Occupational therapy: Physical therapy Reliable and valid evaluation of hand strength is of para- ‘mount importance in determining the effectiveness of various surgical vr treatment procedures, In addition, normative data are needed to interpret evaluation dat; to set realistic treatment ols; ant to assess a patient’ ability to return to employment. The most common norms for grip and pinch strength used in therapy clinics were compiled by Kellor's group,” which sampled 250 individuals in three large age groups. Regression valysis ‘sas performed to predict the amount of right hand (RH) or leit hand (LH) strength an individual of given sex and particular age would demonstrate. Since few left-handed subjects wre tested, their scores were combined with those Of fight-handed subjects. No standardized positioning or in- structions were followed, Test-retest and interrater reliability data were not reported. The Osco pinch meter used in their study is no longer commercially available and there is some {question whether data from use of the newer pinch meters can be validly compared to their norms.” ‘Another study" established clinical norms for grip strength, ‘employing the Martin Vigormeter, which has a soft handle and tas been used clinically with arthritic patients. However, the Jamar dynamometer" has been found? to give the most ac~ curate measure of grip strength, Schmidt and Toews" used the Jamar dynamometer to test rip strength in a large sample, 1128 males (M), 80 females (F), of employee applicants at_a manufacturing plant. Al- though the instructions and positioning were reported t be standardized, description was not sufficient for replication. Unfortunately, as the handles of the dynamometer were coated with a sand-paint mixture and the data were collected in the competitive situation of a pre-job placement interview, gen- eralization from these results is questionable. Recently, the American Society of Hand Therapists, sug- gesting a standardized arm positioning for hand strength tests, concluded that the position of the upper extremity (UE) might influence measurements, and recommended that the patient should be seated with his shoulder adducted and neutrally ro tated, elbow flexed at 90° and the forearm and wrist in neutral position.? Table 1: Characteristics of Subjects: Age, Sex, and Hand Dominan« Men Women Dominance Dominance Ane Age@ RL 2028 wT 69 2529 ye on 6 36 mio 3 39 uM fous aus 4 490 sos 9 Base ior =| 2 0) wo | LD oe on 67 nO nm 6% Ro 3 pisces aslo asl Toral___310 ee In testing the variable of wrist position, Pryce"? found no significant difference in grip strength with test positions at 0° and 15° ulnar deviation, 0° and 15° dorsiflexion, or any com- bination of these. Kraft and Detels!® found no significant dif- ference with test positions at 0°. 15°, and 30° dorsiflexion (O° ulnar deviation) in measuring grip strength. Both studies"? found grip strength to be significantly less at 15° of volarflex- Mathiowetz and associates!? used standardized procedures, (subject position and instructions) to assess the reliability and validity of grip strength and pinch evaluations. The highest test-retest reliability for each test was achieved when the mean of three trials was utilized. The Jamar dynamometer and the BAL pinch gauge® had the highest calibration accuracy of the instruments tested.'® No normative data based on these stan- dardized procedures have previously been reported “The primary purpose of this study was to establish clinical “Tis sudy was fanded in pat by 3 grt ram the American Ocopatins Ther ans Founstion "imited ov pubicsion December 23.1982. Accepted Mach 21, 1984 ‘Arch Phys Mad Ret bl Vo 66, February 1985, n Fig {—Grip strength measurement: This standardized ‘arm and hand positioning was used forall hand strength measurements. norms for men and women aged 20 to 75+ years for hand strength e,aluations based on standardized procedures and in- structions.'” A second purpose was to compare the hand strength cf dominant and nondominant hands. METHOD Subjects, The study included 628 volunteers (310 men, 318 women) aged 20 to 94 years. Subjects were interviewed at shopping centers, fairs, senior citizen centers, a rehabilitation center (stv), and a university. All subjects were from the seven-county Milwaukee region, which includes urban, sub- urban, and rural areas. Therefore it was assumed that a broad range’ of socioeconomic and occupational groups was ob- tained. Subjects were divided into 12 age groups (table 1) of five-year intervals, except for the 75+ age group. All subjects in the 20 to 59 year groups were free from disease or injury that could alfect their UE strength. Subjects 60 years and above had the following less stringent criteria: a) no acute pain in their arms and hands, b) at least 6 months post-hospitalization ‘heart attack or any surgery), ¢) subjects continued to carry on a normal lifestyle without restriction in their activity level be- ‘cause of @ health problem. 2h (left is thumb tip to index fingertip. Key pinch (center) Is thumb pad to later Fig3Frequency polygons for male and female, right-grip strength Procedures. A brief interview preceded all testing, to de- termine if subjects met the above criteria. This study was part of a larger study which included two dexterity tests: the Nine Hole Peg Test and the Box and Block Test (unpublished data). ‘The hand strength testing followed the dexterity tests. Grip strength was tested first (fig 1), followed by tip (two- point) pinch, key (lateral) pinch, and palmar (three-jaw chuck) pinch (fig 2). For each of the tests of hand strength, the sub- jects were seated with their shoulder adducted and neutrally rotated, elbow flexed at 90°. forearm in neutral position,” and ‘wrist between 0" and 30° dorsiflexion and between 0° and 15° ulnar deviation.'®-!3 For each strength test the scores of three successive tials were recorded for each hand. Equipment. The standard, adjustable-handle Jamar dyna- ‘mometer, reported as the most accurate for measuring grip strength,!+!2 was used. For standardization, it was set at the second handle position for all subjects. The dynamometer was. lightly held around the readout dial by the examiner to prevent inadvertent dropping, ‘The B&L pinch gauge, used to measure tip, key, and palmar pinch, was held by the examiner at the distal end to prevent dropping. Scores were read on the needle side of the red read- ‘out marker, The calibration of both instruments was tested periodically during the study aspect of middle phalanx of index finger. Palmar pinch (right) is thumb pad to pads of index and middle fingers. ‘ADULT PINCH AND GRIP STRENGTH, Mathiowetz " ‘Table 2: Average Performance of All Subjects on Grip Strength (pounds) Men ‘Women Age Hand Mean 3D, SE Low High Mean = tow Bish aaa R i026 or 167 704 is a6 9s L i i oh) n 130 610 na 3 88 25.29 R me O44 % 158 745 BS 8 o7 ie hos 23 7 9 3s 22 8 or sos R ae 2s 3 70 170 87 192 46 7 L oa ai a 66 680 07 36 us ase R N07 oct al 7% 74 108 9 99 i. 129007 a 663 ny 23 2 or sovts R Nes 07 8 704 ws 2a 38 os L 128 Nee a 2 623 toa 25 35 3 15.49 R 9 03 5 22 Is) 30 3 10 L mos 8928 43 58 560. a7 2s 7 8 sos R 136 eae a) ” os ij 38 8 i 1019 i708 oa 0 573 oe a 35 76 sss0 R wit 67S 2 373 ns 2s 3 6 L a2 Be SL 8 473 ne 2a 3 %6 0.68 R 7 eA? 3 551 oe a0 3 7 if easel 2 437 foie zo) » 6 65-69 R on 20s 40 56 36 9718 is 8 L we 838 8 a0 e245 » By 70-74 R 300 US 4D Py 36 uy 22 3 7% ic oe kh 37 2 aus m2 19) 2 st 184 R 67 0 042 0 26 Wo 23 s 65 L sso i703. 31 16 somes Py 61 mi R Tos3 RS 2 8 1700.96 2s a subject L a eer see n 39. is.7ee 0.0 23 us. Instructions, Standardized instructions described by Ma- 5) the average scores were relatively stable to 55 to 59 years thiowetz and associates!? were used, before the gradual decline began. Thus it was not surprising that the inverse relationship between age and hand strength was higher for grip strength than for pinch strength (tables RESULTS a rip streng pi ath 6.7). In general the highest correlations were achieved be- In general, grip strength peaked within the 25 to 39 age tween the right and left hand scores for each hand strength test group for both men and women subjects (table 2) and gradually (eg, right grip and left grip) declined thereafter. For tip, key, and palmar pinch (tables 3- Data for both sexes (tables 2-5) demonstrated that the right, Table 3: Average Performance of All Subjects on Tip Pinch (pounds) Men ‘Women Age Had Mean SD SSE tow gh Mea SE Tow High wa R Tho 30 ‘7 " 23 Th 2 2 ® 16 L 20 23 3 2 3 os 17 5 4 25.29 R 63 sa es 0 3 9 ts 3s § 16 5 3 52 8 2 36 13 us 3s 8 8 so R 176 67 7 2 25 26 30 58 5 0 L 6 8 3 0 2 ny 2a 5s 2 7 3539 R io 36 ” 2 ” M6 zs 0 4 9 L m7 38 % ‘0 2 9 aa ra a 16 R 08 39 ® u 2s us 2 9 5 5 L 17 35 ss 2 25 mt 30 Ss 6 a R 187 49 2 2 » 133 30 0 9 9 I 16 a 7 a 2 1 n % 7 i sins 8 a “0 iy " By is 22 a 9 i 1 ink 39 7 2 26 is 2a ” 7 6 ss59 R 166 33 7 " 6 7 7 i 4 6 ic iso 33 at ity 2% wa ba » 4 3 one R 138 39 40 9 2 wo ra e 7 a L 183 32 76 9 B 39 20 39 6 1s 65.69 R 20 42 3 " n 106 20 39 15 L Is 29 55 0 2 ws la 4s a 70-74 R Ba 26 32 " 2 wo 26 48 1 1s ic BS 26 1 10 2 98 33 3 6 a ast R 140 Ba ss 7 2 96 as 38 4 6 L 139 32. 75 5 as 93 24 a 4 a a R 170 41 2 7 Py 113 26 is 4 0 subjects is Io £0 2 £ 36 tos 24 in 4 i [Arch Phys Mod Rehabil Vol 65, February 1985 n ADULT PINCH AND GRIP STRENGTH, Mathiowetz Table 4: Average Performance of All Subjects on Key Pinch (pounds) Men Women Ave Hand Mean SD SE aw Hi 30 SE___iLow iow R 260) 38 6s u 20 9 rm L 28 34 6 Sr 21 ‘a1 B a0 R 267 39 36 0 1 21 41 4 i 230 a 85 0 » 1 “at Bb om R aot 35 95 2 36 30 Pa B L 262 a 38 n 36 36 70 2 36.9 R 261 32 65 a 2 20 0 a t 236 39 7 8 2 33 Q sot R 256 26 50 2 3 34 56 0 it 2s 40 7 19 31 Bu 55 : asa0 R 258 39 3 » 35 32 “ B L 238 $4 8 i 2 29 ss 8 so-st R 267 Py 8 » Ps 25 0 B ic 26.1 32 8s 20 n 27 3 2 55.89 R 220 42 or 8 3 23 30 it L 230 a vo B 31 22 4 2 co.6s R 232 sa mB ia x 27 5s 0 L 22 a 86 16 3 23 30 10 65.69 R Ba 39 18 0 2 26 9 10 L 20 36 70 0 8 2s ‘3 10 048 R 193 2a 97 16 25 29 a 3 L 192 30 59 5 8 30 56 8 1+ R 203 46 a 0 3 23 4 a L ist 30 38 3 2s 26 30 1 an R 235 46 26 9 3 30) 17 3 subj L BY 46 26 " 2 3d i 1 hand was stronger than the left hand. However, within specific ige groups there were a few exceptions (0 this. Men were stronger than women on all hand strength tests. For example. Tigure 3 shows this difference in grip strength; the figure also Jemonstrites a relatively normal distribution of scores. Data fi right and left hand-dominant subjects, analyzed separately (table 7), show little functional difference between the mean scores of right hand-dominant and left hand-domi- ‘nant subjects. In all cases except for tip and palmar pinch of left hand-ominant women, the mewn right hand scores were larger than the mean left hand scores. For these reasons and due to the small percentage (7%) of left hand-dominant sub- jects, the normative data presented in tables 2-6 are the com- bined scores of right and left hand-dominant subjects. ‘Table 5: Average Performance of All Subjects on Palmar Pinch (pounds) Males Females Ase Hang Mean SD SE Tow Wigh Mean ——SSD_SCSSE sow «High ma R 266 33 105 ry 4 23 48 W a 257 58 Coe 5 2 163 De 86 i 25.29 R wo | 43 3 i 3s 07 32 2 B L 21 32 a 9 x6 0 30 Ss B om R 23 a7 1 Is H 193 So. ot 2 L asa 57 Ko Is 7 wt ay rt 2 a9 R 262 4 8 9 % ms 42 BS B » L 289 sa 7 ia “ in a b » ana R 385 33 as 0 n 10 Fn 56 10 a i asa 43 96 15 ” 166 35 8 10 Fs 5.49 R 20 33 6 0 3 9 30 “0 2 n t a7 34 7 he n Ws De o 2 a suse w ase Sa Ko is 36 m3 uM o n Fy L 380 5a 16 6 %6 Ios 29 5? 2B 2 $8.89 R 27 48 106 16 * 160 at 8 u as L 23 45 * 2 2» Iss 30 ot u 2 eos R a8 3 ro i 2 is FM ot 10 20 L 313 32 6s is 2 183 Fa] 5 0 20 65.60 R aa 30. 38 is 2 182 a 9 A 20 L 212 a 30 4 3» By ae st 8 2 v0.78 R ie 34 6 “4 n tea 26 8 5 9 L ss 33 5 5 2 140 15 35 0 7 154 g rs 2 8s 9 26 120 26 S 5 7 L ie 38 7 wo 2s 11s 2s 32 6 16 mi R 24 50) 2s 9 a5 16.3 3a 21 © 3 ‘ube L Bo 53 30 w 2 187 36 20 8 2 [Arch Phys Mod Rehabil Vol 66, February 1985 ADULT PINCH AND CNP STRENGTH, Mathiowetz n Table 6: Correlation Coetticients for All Subjects Variable ee Grip Grip RTI Rekey ___L-Rey Mas Age 00 a es “2 as “9 RGrip 100 9 0 37 9 6 LGnp 00 39 30 82 0 Rte von 76 o 32 Lip 1.00 71 i Reker 85 65 et Ley 00 57 ‘ RePatmar 0 + LPaimar Von Females ‘Ate 100 -8 -61 ee as as -4 RGnp 00 0 a 3 3 3 S Lone 00 “6 7 61 3s 56 Rip 0° 75 68 83 56 S Lp 00 58 66 50 oT Rkey , 00 33 +8 6 Uke 00 a RPalnae 10 SI LPaimar Lo DISCUSSION cent study would appear to support the latter approach because When the results of this study are compared to those of a similar study by Kellor’s group,” several observations can be ‘made. Grip strength (right and left hands) of males improved in 14/24 aye groups while grip strength of women improved in 21/24 age groups. Overall the male scores are similar to those in Kellor’s study but female scores have improved es- pecilly in the 20 to Sd-year group. It might be speculated that the hand strength ef women may have increased as a result of ‘hanging sex roles in our society. However, further investi- tition is needed resolve this question The sens: for tp, key, and palmar pinch improved in this study at all M and F age groups when compared to Kellor’s report, It may be speculated that both M and F pinch strength has incre wed! since 1971; yet. if this were true, a similar in crease in grip strength would also be expected. Since this did not occur. Trombly’s speculation, "” that the newer pinch gat used in this study reads higher than the Osco pinch meter used in Kellor’s study. appears to be supported. It is speculated that the improved M and F pinch strength scores of this study are more related to test instrument differences than to actual im proved pinch strength scores. If this is true, therapists using he newer pinch gatige should not use Kellor’s normative data to interpret test results. Previous studies®:"*! have established that there is a re lationship between hand strength and age. This was confirn in our present study. especially for grip strength, Kellor de- veloped normative data based on a linear inverse relationship. that is maninnal hand strength was achieved at 20 years and decreased with increasing age. The data from our Study and others! would support a curvilinear relationship, with hand strength peaking somewhere between 25 and 50 years of vge and decreasing thereafter. ‘Therefore, use of a linear regression to predict adult hand strength scores needs (0 be questioned Some previous studies''5-1© presented their data on hand dominance as major/minor hand or dominanwnondorninant hand ‘Other studies!” ignored the issue of hand dominance, due to the small percentage (less that 10% of their sample) of LH. subjects and combined their data with RH subjects. Our pres in 6/8 tests (table 7) the mean RH strength score of LH-dom- inant subjects was higher than their left. With these hand strength tests and with the method used co determine hand dominance ‘Table 7: Comparison of Right Hand-Dominant and Left Hand- Dominant Subjects: Four Tests of Hand Strength, pounds, [Right hand domina Hana Test Dominance Mean R Gap R Tos L i336 608 Leip R L R —Tippinch R L Tip pinch R L R Key pinch R L L Key pineh R L R Palmar pinch R t L— Palmae pinch Right hand dominant ana Tet R Gap Lo Gap RO Tip pinch Tippin R Key pinch L key pinch RS Palmar pinch Palmar pinch m ADULT PINCH ANO GRIP STRENGTH, Mathiowetz in this study, the approach of combining scores of RH and LH subjects would uppear justified. The relatively smal difference between RH and LH Scores suggests that some subjects will do better with their LH, even when reported to be right-handed. Some limitations have been noted in the analysis of the present report: It is not known whether a sample of hand strength ‘of a Milwaukee-area population is representative of the whole country, Due to time and money constraints. our subjects were not selected randomly. Since all were volunteers, there is a cchanee that some who thought they might do weil would be riore likely to participate than any who thought they might do poorly. This could cause a biased sample in favor of higher hand strength scores. There was an attempt to avoid a com- petitive atmosphere at the testing sites, to decrease the chance ‘of this happening. While testing tip pinch for this study, some subjects with long fingernails had difficulty assuming the rec- ‘ommended positioning (fig 2), while others had difficulty maintaining the position as they were pinching (index finger ‘or thumb would hyperextend andlor slip off the meter). When these problems were encountered, subjects were tested as close to the recommended positioning as possible. Recently the stan- dard Jamar dynamometer has been slightly modified (calibra tion screw moved to the center of the readout disl). Although not anticipated to affect scores, this needs to be verified by turther research, CONCLUSIONS, ‘To improve the reliability and validity of hand strength eval- uations the following recommendations are made: (1) Stan- ardized positioning and instruction should be followed: (2) the averay of three trials should be used; (3) the dynamometer tnd pinch gauge described should be used for data collection: [41 scores sbtained should be compared to the appropriate age snd sex cssegories for interpretation; (5) the calibration of the dynamometer and pinch gauges should be checked regularly (6) the same test instrument should be used for pre- and post resting. Acknowledgments: The authors thank Frankie Stein, PRD. OTR. for re search and satisieal consultation: Cheryl Rennes and Lori Doaahoe fo ssistince in data election and analysis. We aso thank the many paces and pecple who helped make this study posible: Waukesha (WI) County Fair (Terry Foreman! Rummage-O-Rama (Walter Rsner, Northridge and Sout fidge Shopping Center, Fest Mexicana, Washington Park Senior Center (ety Marek). McGovern Patk Senior Center (Gloria Hal) and Sacred Heart Retaliation Cenier (Elaine Strchota ADDRESS REPRINT REQUESTS TO: Vinst Mathiowet2, MS, OTR Occupational {ner of Wrenn Milwaukee PO Ure 413 Milwaukee, WI S3201 ‘Arch Phys Mod Rohzbi! Vol 66, Fe 1. Agnew Pd. Dip OT, Maas F: Hand function related to age and sex. Arch Phys Med Rehabil 63:269-271, [982 Bechtol CO: Grip test: Use of dynamometer with adjustable han dle spacings. J Bone Joint Surg (Ara) 36:820-824, 852, 1954 3, Fess EE, Moran C: Clinical Assessment Recommendations. In- lianapolis, American Society of Hand Therapists. 1981 4, Fike ML, Rousseau E: Measurement of adult hand strength: com: parison of two instruments, Occup Ther J Res 2:4349, 1982 5. Fisher MB, Birren JE: Age and strength. J Appl Psycho! 31:490— 497, 1947 6, Jack SS, Ries PW: Current estimates from national health intr view survey: United States, 1979. Vital and Health Statistics. Series 10-136, DHHS Pub No (PHS) 81-1564. US Deparment of Health and Human Services, Public Health Service, Apr 1981 17. Kellor M, Frost J Silberberg N, Iversen 1, Cummings &: Hand, strength and dexterity. Am J Occup Ther 38:77-83, 1971 8. Kirkpatrick JE: Evaluation of grip joss. Calif Med 88:314320, 1956 9, Kjerland RN: Age and sex differences in performance in motility and strength tess. Proc lowa Acad Sci 60:519-S23, 1952 10, Kraft GH, Detels PE: Position of function of wrist. Ar ‘Med Rehabil $3:272-275, 1972 1, Lunde BK, Brewer WD. Garcia PA: Grip strength of college ‘women, Arch Phys Med Rehabil $3:491-493, 197: 12, Mathiowetz V, Weber K. Volland G, Kashman N: Reliability and validity of hand strength evaluation, J Hand Surg 9A:222~ 226, 1984 13, Pryce JC: Wrist positon between newt facilitates maximum power grip strength, J Biomechant SUL, 1980 14, Schmidt RT, Toews JV: Grip srength as measured by dhe Jamar dynamometer, Arch Phys Med Rehabil §1:321-327. 1970 15, Swanson AB, Matev 1B, Groot G de: Strength of hand. Bull Prosthet Res BPR 10-14: 145-153. Fall 1970 16, Thorngren K-G. Werser CO: Normal grip strength. Acta Orthop Scand £0:255-259, 1979 ‘Trombly CA (ed): Occupational Therapy: for Physical Dysfunc- tion. Ed 2, Baltimore. Williams & Wilkins. 1983 Phys Suppliers 4, Jamar dynamometer, Asimov Engin ‘90028 . BAL pinch gauge, B&L Engineering. Sante Fe Springs. CA 90670 Ww ing Co. Los Angeles, CA

You might also like