Grip Strength Weakness Research Articles

A Case Report of Proximal Palm Giant Lipoma Leading to Double Nerve Compression, with a Brief Literature Review

Summary: Lipomas are frequently found as benign neoplasms in humans, mainly in the head, neck, and upper limb regions. Because of their rare occurrence in hands and digits, such cases attract researchers’ attention. A case description of a 28-year-old Saudi male patient is presented with a large-size lipoma at the distal forearm, carpal tunnel, and Guyon canal area, with numbness of the central three digits and grip strength weakness of his left hand. The nature of the lesion was a benign, subcutaneous, multilobulated lipoma, removed surgically to prevent malignant transformation and deterioration in neuropathy.

Factors that interfere with immediate return to activity following volar locking plate fixation for distal radius fractures.

In the present study, the clinical findings that interfere with the immediate return to activity following volar locking plate (VLP) fixation for distal radius fractures were investigated. A total of 95 patients who underwent VLP fixation for distal radius fracture between July, 2014 and January, 2022 were divided into a good group (good score and outcome; n=86; 22 males and 64 females; median age, 61 years) and a poor group (poor score and outcome; n=8; 8 females; median age, 63.6 years) according to the quartiles of the disabilities of the arm, shoulder and hand (Q-DASH) score, at 1 month following VLP fixation. The duration from injury to surgery, the direction of fracture dislocation and radiographic parameters [radial inclination (RI), volar tilt (VT) and ulnar variance (UV)] at the time of injury were examined. Radiographic parameters (RI, VT and UV), the range of motion of the wrist joint, grip strength ratio and visual analog scale (VAS) at 1 month following VLP fixation were also examined. These parameters were compared among both groups. Moreover, logistic regression analysis was performed to determine whether these factors were independently associated with a poor Q-DASH score at 1 month following VLP fixation. At the time of injury, fracture displacement was significantly higher in the poor group (VT, -23.8˚; UV, 4.2 mm) than the good group (VT, -6.5˚; P=0.02; UV, 1.3 mm; P=0.01). No differences in the other parameters were observed between the groups. At 1 month following VLP fixation, the grip strength ratio (17.2%) in the poor group was significantly lower than that in the good group (43.8%, P<0.001), while the VAS score (5.6) in the poor group was significantly higher than that in the good group (2.4, P<0.001). Logistic regression analysis revealed that VT and UV at injury (P<0.05), grip strength ratio (P<0.001) and pain (VAS score) (P<0.001) were all independently associated with a poor Q-DASH score. On the whole, the present study suggests that large amounts of fracture displacement, weakness of grip strength and post-operative pain can be factors interfering with the return to activity immediately following VLP fixation.

Association of diet quality with hand grip strength weakness and asymmetry in a multi-ethnic Asian cohort.

Hand grip strength (HGS) is an important diagnostic tool for sarcopenia and a reliable predictor for age-related chronic diseases and mortality. Interventions in nutrition have been shown as a low-cost strategy to maintain muscular strength and mass. However, there are limited data on the effect of diet on HGS in Southeast Asian populations. This study aims to investigate the association of diet quality with HGS weakness and asymmetry in a multi-ethnic population in Singapore. This cross-sectional study used data from the Singapore Multi-Ethnic Cohort (n = 1547). Dietary data were collected using a validated semi-quantitative FFQ and summarised as the Dietary Quality Index - International (DQI-I). HGS was calculated as the maximum value of six measurements from both hands. HGS weakness and asymmetry were defined using well-recognised criteria. Multivariable linear regression and logistic regression were utilised for continuous and binary outcomes, respectively, adjusting for age, sex, ethnicity, physical activity and smoking status. It was found that the highest quartile of DQI-I was significantly associated with higher HGS (β = 1·11; 95 % CI 0·41, 1·82; Pfor trend < 0·001) and lower odds of HGS asymmetry (OR = 0·71; 95 % CI 0·53, 0·94; Pfor trend = 0·035) and both HGS weakness and asymmetry (OR = 0·50; 95 % CI 0·32, 0·76; Pfor trend = 0·004). Among the different components of DQI-I, only dietary adequacy was significantly associated with higher HGS (Pfor trend < 0·001) and lower odds for both HGS weakness and asymmetry (Pfor trend = 0·006). Our findings support that DQI-I, an indicator of overall diet quality, can be used to provide dietary guidelines for prevention and management of muscle wasting, sarcopenia and frailty.

A pilot study: handgrip as a predictor in the disease progression of SCA3

BackgroundSpinocerebellar ataxia type 3 (SCA3) is an inherited, autosomal, and rare neurodegenerative disease. Serum/plasma biomarkers or functional magnetic resonance imaging used to assess progression, except for neurological examinations, is either inconvenient or expensive. Handgrip strength (HGS) may be considered as a biomarker to predict the progress of SCA3 and align with the alteration of plasma neurofilament light chain (NfL) and Scale for the Assessment and Rating of Ataxia (SARA).MethodsPatients with SCA3 and healthy subjects were recruited from Changhua Christian Hospital. SARA, body mass index (BMI), and NfL were obtained for both groups. HGS was measured using a Jamar Plus + hand dynamometer.ResultsThis study recruited 31 patients and 36 controls. HGS in the SCA3 group revealed a profound decrease (P < 0.001) compared with normal subjects. HGS also had a negative correlation with SARA (r = − 0.548, P = 0.001), NfL (r = − 0.359, P = 0.048), and a positive correlation with BMI (r = 0.680, P < 0.001). Moreover, HGS/BMI ratio correlated with SARA (r = − 0.441, P = 0.013). Controlling for gender and age, HGS still correlated with the above clinical items. The initial hypothesis was also proved in SCA3 84Q transgenic mice, showing grip strength weakness compared to normal mice.ConclusionsHGS can be an alternative tool to assess the clinical severity of SCA3. Further research is needed to investigate the underlying mechanisms.

The role of Limch1 alternative splicing in skeletal muscle function.

Postnatal skeletal muscle development is a highly dynamic period associated with widespread alternative splicing changes required to adapt tissues to adult function. These splicing events have significant implications because the reversion of adult mRNA isoforms to fetal isoforms is observed in forms of muscular dystrophy. LIMCH1 is a stress fiber-associated protein that is alternatively spliced to generate uLIMCH1, a ubiquitously expressed isoform, and mLIMCH1, a skeletal muscle-specific isoform containing six additional exons simultaneously included after birth in the mouse. CRISPR/Cas9 was used to delete the six alternatively spliced exons of LIMCH1 in mice, thereby forcing the constitutive expression of the predominantly fetal isoform, uLIMCH1. mLIMCH1 knockout mice had significant grip strength weakness in vivo, and maximum force generated was decreased ex vivo. Calcium-handling deficits were observed during myofiber stimulation that could explain the mechanism by which mLIMCH1 knockout leads to muscle weakness. In addition, LIMCH1 is mis-spliced in myotonic dystrophy type 1, with the muscleblind-like (MBNL) family of proteins acting as the likely major regulator of Limch1 alternative splicing in skeletal muscle.

Effect of TheraBand Flex Bar versus Strengthening Exercise in Patients with Lateral Epicondylitis

Abstract Background Lateral epicondylitis (LE) is an exertion or sporting-connected aching condition of the extensor muscles of the forearm. The core warning signs are pain and soreness of the outside on the elbow and grip strength weakness. The investigation aims to differentiate the effect of TheraBand flex bar versus strengthening exercise on pain, grip strength, range of motion, and functional status. Objectives To find the effects of TheraBand flex bar, strengthening exercise, and compare the effects of Thera band flex bar versus strengthening exercise on the elbow pain, handgrip strength, elbow and wrist range of motion, and functional disability status in lateral epicondylitis. Design Quasi-experimental study. Methods Thirty (30) patients with lateral epicondylitis were enrolled, both male and female, randomly assigned to control or 6-week training groups. They were subdivided into two groups. Subjects were pre-tested and post-tested using a hand-held dynamometer, the VAS, PRTEE Questionnaire Functional status, and goniometer. Results The results showed a statistically significant difference between pre and post-treatment in the study batch. The results show that Batch-1 and Batch-2 were significantly improved with p-values of 0.000, 0.004, 0.000, 0.001, 0.001, 0.004 at p &lt; 0.05. Conclusion In this study, the TheraBand flex bar and the strengthening exercise for lateral epicondylitis effectively reduced pain, enlarged the functional status, and improved the range of function within 30 subjects with lateral epicondylitis. The study concluded that TheraBand flex bar in Batch-1 and strengthening exercise in Batch-2 significantly improved VAS, PRTEE, handgrip strength, and ROM. The study's outcome suggests that TheraBand flex bar and strengthening exercise of extensors muscles of the wrist can be productive for the treatment among lateral epicondylitis (LE) sufferers.

Mapping frailty in people living with HIV: A nationwide study in Greece.

Frailty is known to affect people living with HIV prematurely, compared to the ageing seronegative population. In this cross-sectional study, we aimed to assess frailty prevalence in people living with HIV in Greece and find associations of frailty criteria with clinical data. Demographic and clinical data were collected from 477 participants in six HIV clinics. Fried's frailty phenotype was used to assess frailty prevalence, and participants were classified as frail, pre-frail or robust. Associations of several factors with overall frailty phenotype, as well as with frailty criteria, were explored. The median age was 43 years old (IQR=51.5) and 444/477 (93%) were men. Most of the participants (429/477, 93.5%) had an undetectable HIV viral load, and a CD4 cell count over 500 cells/μl (366/477, 76.7%). Frailty assessment classified 285/477 (62.1%) as robust, 155/477 (33.8%) as pre-frail and 19/477 (4.1%) as frail. Weakness in grip strength was the most prevalent criterion (128/477, 26.8%), followed by exhaustion (46/477, 9.6%). Lower CD4 cell count, history of AIDS diagnosis, CNS disorders, psychiatric diagnoses, and polypharmacy were strongly associated with frailty. Although the prevalence of frailty in people living with HIV in Greece is uncommon, when combined with pre-frailty over a third of people are affected, which requires attention in clinical practice. The physical and psychological aspects of frailty highlight the need for a holistic approach to prevent or counteract it. The diverse associations of frailty criteria with HIV-related and non-HIV-related factors suggest a possible variation in people's different healthcare needs.

Frailty trajectory among community-dwelling middle-aged and older adults in Korea: evidence from the Korean Longitudinal Study of Aging

BackgroundThere is no study on the frailty trajectory including both middle-aged and older people, and the understanding of the long-term frailty trajectory is insufficient. This study aimed to identify the frailty trajectory, subgroups of the frailty trajectory, and the predictors that differentiate these subgroups among community-dwelling middle-aged and older adults.MethodsThe participants were 9,775 individuals aged 45 years and older who participated in the Korean Longitudinal Study of Aging (2006–2018). Frailty was measured using a frailty instrument comprising three items: grip strength weakness, exhaustion, and social isolation. Latent growth curve modeling and latent class growth modeling were performed to identify the frailty trajectory and latent classes of the trajectory. Multinomial logistic regression was used to confirm the predictors that classified the latent classes.ResultsOver 12 years, the slope of the frailty trajectory among the participants showed a gradual increase. In addition, there was a difference in the latent class of frailty trajectories among middle-aged and older adults. The middle-aged participants were divided into two groups: maintaining robustness and changing from pre-frailty to robustness. The older adults were divided into three groups: maintaining robustness, maintaining pre-frailty, and changing from the frailty to pre-frailty group. Regular exercise, cognitive dysfunction, and social participation were significant predictors that differentiated each latent class in both middle-aged and older adults; additionally, current smoking and the number of chronic diseases were significant predictors in middle-aged people.ConclusionsVarious subgroups within the frailty trajectory existed among community-dwelling middle-aged and older adults. To reduce frailty, it is necessary to intervene with modifiable factors appropriate for each age group.

Prospective outcome analysis of ulnar tunnel syndrome: Comparing traumatic versus non-traumatic etiologies

Ulnar tunnel syndrome (UTS) is relatively uncommon compared to the carpal tunnel or cubital tunnel syndromes. Few reports dedicated to the functional outcomes after surgical intervention of the UTS exist. Herein we compare the outcomes of patients with UTS of different etiologies. Patients diagnosed with UTS between 2016 and 2020 were recruited. Ulnar tunnel release was performed in all patients, along with other necessary osteosynthesis or reconstructive procedures in the traumatic group. Patients were followed-up every six months post-operatively. Outcomes measured include: objective evaluations, subjective questionnaires, records of clinical signs, and grading of the British Medical Research Council scale for intrinsic muscle strength. 21 patients were recruited, and favorable results were noted in all of them after surgery. Traumatic UTS patients had a worse initial presentation than the non-traumatic cases, but had a greater improvement after surgery and yielded outcomes comparable with those of the patients without trauma. Patients with aberrant muscles in their wrists had better outcomes in some objective measurements than those without aberrant muscles. Ulnar tunnel release improves the outcome of patients regardless of the etiology, especially in patients with trauma-induced UTS. Thus, a proper diagnosis of the UTS should be alerted in all patients encountering paresthesia in the ulnar digits, ulnar-sided pain, weakness of grip strength, or intrinsic weakness to ensure good outcomes.

Abstract WMP38: The Functional Significance Of Distal Arm Motor Deficits After Stroke

Background: Much of human behavior revolves around use of the hand, yet distal arm motor deficits are not part of the NIH Stroke Scale (NIHSS), and so their measurement is omitted from many guidelines and care pathways. We examined the frequency of distal arm motor deficits and their functional implications. Methods: Patients in the STRONG Study were examined 1-10d and again 90 d post-stroke. Grip force, expressed as the ratio of paretic/nonparetic hands, and the NIHSS were measured serially. The modified Rankin (mRS) and Fugl-Meyer arm motor (FM) scales were measured at d90. Results: There were 763 patients, with age = 62.5±15.0 (mean±SD), acute NIHSS = 4 [2-9] (median [IQR]), and day 90 mRS median = 2 [1-3]. Grip force was available in 748 acutely and in 439 at d90. Weakness in grip strength was present in 60.2% acutely and 52.2% at d90. Acutely, grip force was not related to NIHSS total score (r=.04, p=.3) after accounting for proximal motor deficits (NIHSS Q5); at d90, there was a weak relationship (r= -0.15, p&lt;.0001). Proximal weakness was only partially related to distal motor deficits at both timepoints (r = -0.48 to -0.53, p&lt;.0001). At d90, grip force explained 24.6% of the variance in mRS score (p&lt;.0001). D90 grip force showed convergent validity, correlating strongly with the distal arm motor FM score (r=.64, p&lt;.0001). Conclusions: In this mild-moderate stroke population, distal arm motor deficits were common, were poorly captured by the NIHSS total score, and did not simply echo proximal arm motor deficits. Distal arm motor deficits were strongly related to level of global disability at d90. These findings argue that measurement of distal arm motor deficits should be included in guidelines and care pathways after stroke.

Which injections are effective for lateral epicondylitis?

Placebo injections actually improve lateral epicondylitis at high rates. No other injections convincingly improve it better than placebo.Corticosteroid injection is not superior to saline or anesthetic injection (strength of recommendation [SOR] A, systematic review of randomized controlled trials [RCTs]). Platelet-rich plasma (PRP) injection is not superior to saline injection (SOR A, meta-analysis of RCTs).Botulinum toxin injection, compared to saline injection, modestly improved pain in lateral epicondylitis, but with short-term grip-strength weakness (SOR A, meta-analysis of RCTs). Prolotherapy injection, compared to saline injection, improved pain at 16-week, but not at 8-week, follow-up (SOR B, one small pilot RCT).Hyaluronic acid injection, compared to saline injection, resulted in a statistically significant pain reduction (6%) but did not achieve the minimum clinically important difference (SOR B, single RCT).Autologous blood injection, compared to saline injection, did not improve disability ratings (SOR B, one small RCT).

Development of the Houston-Apollo model for older people living in remote areas in Taiwan.

Senior healthcare is challenging in remote areas, particularly in an economically disadvantaged population. This study examined the benefits of a combined healthcare system (Houston-Apollo model) in improvements of physical performance and medical care utilization of local older people. People aged ≥65 years who participated in congregate meal services were recruited. Using concepts of telemedicine and community health records, participants received consultation from local general physicians, who provided advice or arranged referrals to the National Taiwan University Hospital Yunlin Branch. Physical parameters including blood pressure, body mass index, grip strength, walking speed, and five times sit-to-stand test (FTSST) were transferred to the National Taiwan University Hospital Yunlin Branch and local doctors in a timely manner. Changes in physical parameters and utilization of healthcare facilities were measured at the beginning of recruitment and 1 year later. In the 470 registered participants, 66% had hypertension, 50% had weakness in grip strength, 58% were slow at FTSST and 78% had disability in 6-meter walking speed. In total, 97 participants were followed up at 1 year. The systolic and diastolic blood pressure (mmHg) decreased from 137.4 to 133.3 (P = 0.019) and from 76.9 to 74.4 (P = 0.008), respectively. The time of FTSST (s) decreased from 11.3 to 10.4 (P = 0.011). The walking speed (m/s) increased from 0.71 to 0.74 (P = 0.039). Medical and dental outpatient usage increased by 2 and 1.14 times, respectively. The Houston-Apollo model could provide benefits for the physical status of older adults, promote proactive and preventive healthcare utilization, and contribute to medical equality. Geriatr Gerontol Int 2021; ••: ••-••.

URBAN-RURAL DIFFERENCES IN THE PREVALENCE OF MUSCLE WEAKNESS AND SLOW GAIT SPEED: A CROSS-SECTIONAL ANALYSIS FROM THE NHANES (2001-2002 AND 2011-2014).

Older adults living in rural areas suffer from health inequities compared to their urban counterparts. These include comorbidity burden, poor diet, and physical inactivity, which are also risk factors for sarcopenia, for which muscle weakness and slow gait speed are domains. To date, no study has examined urban-rural differences in the prevalence of muscle weakness and slow gait speed in older adults living in the United States. To compare the prevalence of grip strength weakness and slow gait speed between urban and rural older adults living in the United States. A cross-sectional, secondary data analysis of two cohorts from the National Health and Nutrition Examination Survey (NHANES), using gait speed or grip strength data, and urban-rural residency, dietary, examination, questionnaire and demographic data. 2,923 adults (≥ 60 yrs.). Grip weakness was defined as either, an absolute grip strength of <35 kg. and <20 kg. or grip strength divided by body mass index (GripBMI) of <1.05 and <0.79 for men and women, respectively. Slow gait speed was defined as a usual gait speed of ≤0.8m/s. The prevalence of GripBMI weakness was significantly higher in urban compared to rural participants (27.4% vs. 19.2%; p=0.001), whereas their absolute grip strength was lower (31.75(±0.45) vs. 33.73(±0.48)). No urban-rural differences in gait speed were observed. Older adults residing in urban regions of the United States were weaker compared to their rural counterparts. This report is the first to describe urban-rural differences in handgrip strength and slow gait speed in older adults living in the United States.

Isolated Dorsal Dislocations of the Fourth and Fifth Carpometacarpal Joints: A Case Report and Review of Literature

Dislocations of the carpometacarpal (CMC) joints without fracture are rare injuries. They commonly involve the fourth and fifth metacarpals of the dominant hand. Missed and incorrect diagnoses are quite frequent due to subtle clinical and radiological findings. Untreated cases may result in chronic disability due to long term pain and weakness in grip strength. Closed reduction is possible when performed early but can be unstable. We present a rare case of unstable dislocation of fourth and fifth carpometacarpal joints treated by closed reduction and percutaneous pinning.

Reduction of stearoyl-CoA desaturase (SCD) contributes muscle atrophy through the excess endoplasmic reticulum stress in chronic kidney disease.

Skeletal muscle atrophy is associated with mortality and poor prognosis in patients with chronic kidney disease (CKD). However, underlying mechanism by which CKD causes muscle atrophy has not been completely understood. The quality of lipids (lipoquality), which is defined as the functional features of diverse lipid species, has recently been recognized as the pathology of various diseases. In this study, we investigated the roles of the stearoyl-CoA desaturase (SCD), which catalyzes the conversion of saturated fatty acids into monounsaturated fatty acids, in skeletal muscle on muscle atrophy in CKD model animals. In comparison to control rats, CKD rats decreased the SCD activity and its gene expression in atrophic gastrocnemius muscle. Next, oleic acid blocked the reduction of the thickness of C2C12 myotubes and the increase of the endoplasmic reticulum stress induced by SCD inhibitor. Furthermore, endoplasmic reticulum stress inhibitor ameliorated CKD-induced muscle atrophy (the weakness of grip strength and the decrease of muscle fiber size of gastrocnemius muscle) in mice and the reduction of the thickness of C2C12 myotubes by SCD inhibitor. These results suggest that the repression of SCD activity causes muscle atrophy through excessive endoplasmic reticulum stress in CKD.

MEDIATING EFFECT OF GRIP STRENGTH TRAJECTORY ON THE ASSOCIATION BETWEEN EXERCISE AND WEAKNESS: A DYADIC APPROACH

This study aimed to explore the mediating effect of grip strength trajectory on the longitudinal association between regular exercise and weakness in grip strength using a dyadic approach. We used six waves of the Korean Longitudinal Study of Aging (KLoSA) collected every two years from 2006 to 2016. The sample was middle and old-aged Korean couples who participated in all six waves of the survey (N=1,967). The outcome variables were husbands’ and wives’ grip strength at Wave 6, coded as a binary variable (0=clinically weak, 1=normal). The mediating variables were husbands’ and wives’ trajectories of grip strength across Waves 1 and 5. Independent variables were three dummy variables indicating couple’s participation in regular exercise (both engaged in regular exercise, only husband did, only wife did). Reference group was both not doing regular exercise. Results showed several significant mediational pathways. For husbands, engagement in regular exercise of both spouses and only husband were associated with higher grip strength at Wave 1, and slower decline in grip across waves was related to lower likelihood of having a clinically weak grip strength at Wave 6. As for wives, engagement in exercise of both spouses was associated with higher grip strength at Wave 1 which in turn was related to lower likelihood of having a clinically weak grip strength at Wave 6. These results suggest longitudinal dyadic processes through which engagement in regular exercise affects weakness in grip strength among older Korean couples.

Biomarker: Trolox equivalent antioxidant capacity and telomere length of Thai elderly people with frailty

Introduction: Thailand has a rapidly aging population; assessing frailty earlier with biochemical markers could identify many adverse outcomes such as disability, hospitalization, and death. We aimed to examine the correlation between Trolox equivalent antioxidant capacity (TEAC), thiobarbituric acid reactive substances (TBARS), and telomere length and frailty for elderly people in Northern Thailand.&#x0D; Methods: A cross-sectional study was performed between May 2017 and March 2018 with a total of 350 elderly aged 60 and older for frailty phenotype assessment by five frailty criteria including unintentional weight loss, exhaustion, slowness, low physical activities, and grip strength weakness. Twenty-eight subjects in both the frailty and non-frailty groups were analyzed for basic clinical parameters, including plasma TEAC, TBARS, and telomere length.&#x0D; Results: Alanine aminotransferase activity, albumin concentration, cholesterol level, and telomere length were significantly low in the frailty group. The albumin level, TEAC, and telomere length were significantly higher between the ages of 60 and 75 years compared to those with non-frailty over 75 years of age. Likewise, albumin and cholesterol levels were significantly higher in the frailty group aged 60–75 years. Albumin concentration, cholesterol level, TEAC, and telomere length were significantly higher in the non-frailty group when compared to the frailty group aged 60–75 years, but no significant difference was found among these biochemical parameters of frailty and non-frailty whose age was above 75 years.&#x0D; Conclusion: The reduction of albumin concentration, cholesterol level, TEAC, and telomere length supports the underlying mechanism of frailty screened by the frailty phenotype tool in a specific age range. However, further analyses with multi-parameters must be validated before the application in clinical diagnosis for frailty.

Improvements in Grip and Pinch Strength and Patient-reported Outcomes After Anterior Cervical Discectomy and Fusion.

Prospective. To evaluate improvements in grip and pinch strength in patients with or without myelopathy and determine patient factors that are predictive of continued postoperative grip strength weakness. The degree to which cervical myelopathy can diminish upper extremity muscle strength has not been objectively characterized. Few studies have investigated the association between the expected improvements in patient-reported outcomes (PROs) and strength in grip and pinch after anterior cervical discectomy and fusion (ACDF). Patients were asked to perform grip and pinch strength tests both preoperatively and at 6-month follow-up. Patients were also administered PRO surveys, which included Neck Disability Index, Short-Form-12 physical composite score and mental composite score, and Visual Analog Scale neck and arm pain scores. Receiver operating characteristic (ROC) curve analysis was used to determine optimum cutoff values of preoperative patient factors to predict postoperative dominant handgrip weakness after ACDF. Patients with radiculopathy demonstrated a significantly greater improvement in Visual Analog Scale arm pain compared with patients with myelopathy. The ROC curve analysis determined the optimum cutoff for preoperative dominant handgrip strength to be 22 kgf. This value demonstrated a sensitivity of 0.89 and a specificity of 0.62. The area under the ROC curve value was 0.71 (95% confidence interval, 0.55-0.88), indicating fair prognostic accuracy of the cutoff for postoperative dominant handgrip weakness. In this prospective, observational study, postoperative increase in grip and pinch strength demonstrated an association with improvement of pain and disability of the neck and overall quality of health regardless of the presence of cervical myelopathy. Preoperative grip strength weakness was found to be predictive of postoperative grip strength deficiency after ACDF. Our investigation suggests the recovery of hand function may be correlated with improvement of PROs after ACDF.

Differences of locomotive syndrome and frailty in community-dwelling middle-aged and elderly people: Pain, osteoarthritis, spinal alignment, body balance, and quality of life

Purpose: To identify differences between locomotive syndrome (LS) and frailty.Methods: A total of 1016 subjects (males 427, females 589, mean age 64 years) were prospectively examined in the Yakumo study. LS was defined as ≥16 on the GLFS-25 questionnaire. Frailty was diagnosed as ≥3 of unintentional weight loss, grip strength weakness, low walking speed, exhaustion, and low physical activity.Results: LS (14.4%) and frailty (10.8%) were more significant in older, female subjects with weaker muscle strength, lower gait speed, severer pain, poorer spinal alignment, and poor quality of life (QOL). LS strongly reflected musculoskeletal and neuropathic pain, knee and lumbar degeneration with poor spinal alignment, and poorer body balance, whereas frailty reflected muscle weakness. In multivariate analysis adjusted for age and gender, the significant independent risk factors were LS (odds ratio (OR) 10.6), frailty (OR 3.6), pain (OR 1.02) for poor physical QOL, and LS (OR 4.4) and lower gait speed (OR 1.6) for poor mental QOL.Conclusion: LS is more strongly related to musculoskeletal factors and may be more important than frailty for poor physical and mental QOL. LS should be checked early especially in independent elderly people to maintain activities of daily living and QOL.

Can early assessment of hand grip strength in older hip fracture patients predict functional outcome?

Decreased muscle strength is not only a risk factor for hip fracture in older patients, but plays a role in recovery of physical function. Our aim was to assess the role of grip strength measured early after hip fracture, and classified according to the EWGSOP2 criteria in predicting short- and long-term functional recovery. One hundred ninety-one patients with acute hip fracture consecutively admitted to an orthopaedic hospital have been selected. A multidimensional geriatric assessment evaluating sociodemographic variables, cognitive status, functional status and quality of life prior to fracture, as well as perioperative variables were performed. Follow-ups at 3 and 6 months after surgery were carried out to evaluate functional recovery. Multivariate regression models were used to assess the predictive role of handgrip strength. The mean age of the participants was 80.3 ±6.8 years. Thirty-five percent of our patients with clinically relevant hand grip strength weakness were significantly older, more often female, had a lower BMI, and were of worse physical health. They also had a lower cognitive level, lower Barthel index, and lower EQ5D scores before fracture. Multivariate regression analysis adjusted for age and gender revealed that hand grip weakness was an independent predictor of worse functional outcome at 3 and 6 months after hip fracture for both genders and in all age populations. Our study supports the prognostic role of hand grip strength assessed at hospital admission in patients with hip fracture. Thus, clinicians should be encouraged to include hand grip assessment in their evaluation of hip fracture patients in the acute setting in order to optimize treatment of high-risk individuals.