Handgrip Strength

Handgrip strength is the maximal force of the hand grip measured with a dynamometer. It is a simple marker of overall muscle strength and nutritional and functional status. Low grip strength predicts disability, longer hospital stay, falls and mortality.

It is used to identify sarcopenia and frailty, and to monitor response to nutritional and rehabilitation interventions.

Usage. It is used in geriatric assessment, nutritional assessment, rehabilitation, and research.

Preparation and technique. The patient sits with the shoulder adducted, elbow flexed to 90 degrees, and forearm in a neutral position. The dynamometer handle is adjusted to the hand size. The patient squeezes maximally for about 3 seconds. Three attempts are made on each hand with rests between attempts, and the best value is recorded.

Reference values. Strength is compared with age- and sex specific norms. A commonly used threshold for low strength in sarcopenia is under 27 kg in men and under 16 kg in women, although cut offs differ between populations and devices.

Contraindications and precautions. Painful arthritis, recent hand surgery, and acute hand injury prevent valid testing.

Interpretation.

• Low grip strength with low muscle mass confirms sarcopenia.
• Low grip strength with normal muscle mass suggests probable sarcopenia or a neuromuscular or nutritional cause.
• A fall in strength over time is more informative than a single value.

Causes of low strength. Sarcopenia, malnutrition, chronic illness, neuromuscular disease, deconditioning, depression, and poor effort.

Critical values and findings needing immediate action. Rapid loss of strength with weakness in other muscle groups requires urgent neurological assessment.

Limitations and artefacts. Results depend on effort, position and handle setting. Pain and arthritis limit performance. Dominance affects values.

Follow up tests. Bioelectrical impedance analysis or DEXA for muscle mass, gait speed, serum 25-hydroxyvitamin D, thyroid function tests, creatine kinase, and dietary assessment.

Special groups. Children use age specific norms. Older adults are the main group assessed. People with hand impairment need an alternative measure of strength.