Authored by Andrew Ryan Lum*
Abstract
Background: People with orthopedic shoulder injuries often have reductions in grip strength and function, but the correlation of these relationship is unclear.
Purpose: Explore the relationship between grip strength scores and functional outcome measures scores for patients experiencing shoulder pain and examine whether occupational therapy intervention was associated with positive changes in grip strength and self-reported function.
Methods: A retrospective cohort study examining the charts of patients seen in an outpatient clinic June 2014-July 2018, with the following inclusion criteria: people 18-85 years of age with acute/chronic shoulder pain, and/or rotator cuff pathology. Patients received therapeutic exercise/ activity; modalities; and functional training. Outcome measurements included baseline/discharge scores for grip strength and the Shoulder Pain and Disability Index (SPADI), a self-report of pain and disability with a total percentage score ranging from 0 to 100, where 0 = best and 100 = worst.
Results: The records of 31 people met inclusion criteria. Grip strength increased (x ̅=7.6± 11.1lbs); SPADI scores decreased (improved) by 26.6±19.7 points. A moderate, negative correlation (r = -0.596, P = .01) was found between initial affected grip strength scores and initial SPADI scores. Conversely, there was positive correlation (r = 0.80, P = .67) between post-intervention grip strength scores and SPADI scores.
Conclusion: Grip strength and SPADI scores improved after a course of occupational therapy. There was also a moderate correlation between pre-intervention grip strength and SPADI scores and a positive correlation between the post-intervention grip and SPADI scores.
Keywords: Grip strength; Occupational therapy; Upper extremity rehabilitation; SPADI
Abbreviations:
• OT- Occupational therapist.
• EMG - Electromyography; UE – upper extremity
• MCID- Minimally important clinical difference.
• SPADI- Shoulder Pain and Disability Index.
• Lbs- Pounds.
• Kg- Kilograms.
Introduction
The upper extremity is comprised of the shoulder complex, arm, forearm, and hand [1,2]. For the upper extremity to function in all ranges and across all tasks, muscle and joint structures need to work well collectively. Deficits in one muscle or joint structure may therefore lead to changes in movement, strength or function in other joints or in overall functional status [3].
Upper extremity performance and functional mobility is better, when the shoulder is stable and pain free [4]. Shoulder pain is the third most common musculoskeletal condition with incidence ranges up to 2.5% [5]. These proximal aspects of the upper extremity can affect functional performance of the hand [6]. Hand grip strength has been found to correlate with strength of other muscle groups and thus can be utilized as a good predictor of overall upper body strength as well as identify people at higher risk of physical disability [7-11]. Grip strength tends to increase into the fourth decade of life while declining at an accelerated rate thereafter [12]. The right hand is characteristically stronger than the left and men typically have higher grip strength than women in the same age range [13].
Changes in shoulder position, health, and integrity have adverse effects on grip strength [2,4,6,7,10,14]. During grip strength testing, the muscles of the rotator cuff help stabilize the humerus4 as well as maintain scapular position in an ergonomically protracted state [6]. While the scapula is protracted, increased activation of muscles surrounding the scapula such as the serratus anterior, upper trapezius, as well as the flexor carpi ulnaris, flexor carpi radialis, and palmaris longus is observed and can further influence and improve grip strength measures [6]. When there is dysfunction in these muscles, through observation of decreased scapulohumeral rhythm and in combination with poor scapular position throughout movement, grip strength can reduce 13.14% in comparison to its norm for the individual [6]. Subsequently, fatigue in the upper extremity following a shoulder exhausting regime and recovery time, has led to a decrease in grip strength and was confirmed through electromyography (EMG) results as well as a reorganization of movement strategies [15]. This evidence illustrates a positive relation between shoulder function and grip strength force [10]. Application and utilization of this relationship could help with prediction of disability and functional limitations [9].
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