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The Open Orthopaedics Journal

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REVIEW ARTICLE

A Review of Handgrip Strength and its Role as a Herald of Health

Raquel A. Minasian1, Stuart H. Kuschner1,* and Charles S. Lane1
1
Cedars-Sinai Medical Center, 8635 West Third Street #. 990W, Los Angeles, CA90048, USA.

Abstract:
Measurement of grip strength using a handheld dynamometer is frequently performed as part of an orthopedic upper extremity examination. We
review the technique of grip strength measurement and evaluation of the possible submaximal effort. What constitutes normal grip strength in one
part of the world is not necessarily normal elsewhere. Additionally, there is considerable evidence, most of which is outside the orthopedic
literature, that diminished grip strength is a proxy for poor health and a predictor of increased mortality.

Keywords: Grip strength, Dynamometer, Sarcopenia, Disability, Morbidity, Mortality.

Article History Received: March 18, 2021 Revised: October 20, 2021 Accepted: November 17, 2021

1. INTRODUCTION Positioning during grip strength measurement can range in

terms of how the handle is held, as well as how the upper
In 1954, Charles O. Bechtol reported grip strength testing
using a hydraulic dynamometer with adjustable settings [1]. At extremity is otherwise positioned. In Bechtol’s 1954 report,
least since then, measurement of grip strength is commonly subjects were shown how to grasp the dynamometer and were
performed as part of a hand examination, typically with a hand- requested to grasp with maximum force at each of the five
held hydraulic dynamometer. The device described by Bechtol handle settings, alternating right and left hands. Subjects were
is given the name Jamar dynamometer and has been called the instructed to sit in a straight-backed chair, with feet flat on the
“gold standard” against which all other dynamometers are floor, shoulder adducted with neutral rotation, elbow flexed at
measured, as well as the most widely cited in the literature [2 - 90 degrees, and the forearm and wrist in the neutral position
4]. It is considered reliable and valid [5]. Other devices have [5].
been used to measure grip strength, for example, pneumatic
Switching handle settings and recording measurements at
bulbs and spring gauges, but hydraulic dynamometers are near-
each of 5 different positions take time. Firrell et al. noted that,
ubiquitous pieces of equipment in the offices of hand and
in a busy clinic, to save time, when using the Jamar
orthopedic surgeons, and grip strength measurements are
dynamometer, typically only one setting (position) is used [6].
routinely obtained [2].
They evaluated 288 normal asymptomatic hands of 4 to 78-
Obtaining grip strength measurement is easy and year-old individuals at 5 dynamometer settings. Eighty-nine
straightforward. The hydraulic dynamometer described by percent had maximum strength at the second setting. They
Bechtol and its subsequent iterations have a smooth handle, recommended grip strength measurement at position 2,
always adjustable, with 5 settings. A dial, facing away from the regardless of age, weight, or hand dimensions.
patient, records force of grip in pounds or kilograms. The
handles do not move when squeezed and therefore, by design, Trampisch et al. supported this recommendation further
provide no feedback to the patient. using a Jamar dynamometer (with digital readout) to evaluate
optimal handle position by measuring grip strength 3 times at
The patients are instructed to squeeze as hard as they can, each of the 5 handle positions for 50 study participants [5].
and a number is generated. However, what to make of this Position 1 was the closest and position 5 was the widest spread.
measurement, is it helpful and if so, in what way? Since They found that the handle at position 2 was the best position
Bechtol’s 1954 paper, many studies have been undertaken to (maximal grip strength) for 70% of participants. They found
answer these and other questions related to the measurement of the mean difference between grip strength at position 2, and
grip strength. each participant’s best position was 0.8kg (2% of mean
*
Address correspondence to this author at the Cedars-Sinai Medical Center, 8635
maximal grip strength). They, therefore, recommended position
West Third Street #. 990W, Los Angeles, CA 90048, USA; Tel: 310-423-5900; 2 for measuring grip strength with the Jamar dynamometer
E-mail: stuart.kuschner@cshs.org having the advantage of being easier and faster as well as

DOI: 10.2174/18743250-v16-e2201100, 2022, 16, e187432502201100

4 The Open Orthopaedics Journal, 2022, Volume 16 Minasian et al.

“sufficiently accurate” as compared to the measurements at maximum grip strength at the second or third handle set, and
multiple different positions. lower strength with a handle set wide and narrow [17, 19].
Stokes, in 1983, proposed that a patient who is voluntarily
Mathiowetz et al. evaluated the effect of elbow position on
trying to demonstrate weakness will, when tested at all 5
grip strength and found significantly greater grip strength with
handle positions, generate a straight-line graph instead of a
the elbow flexed at 90 degrees compared to elbow fully bell-shaped curve [19]. This conclusion has been challenged by
extended [7]. Additional recommendations are for the shoulder others [12, 15, 16, 21]. For example, Niebuhr and Marion
to be adducted and neutrally rotated and for the forearm to be reported that subjects, with proper instruction as to the amount
neutral [8]. of effort to exert, can produce feigned submaximal efforts
The ideal number of grip strength measurements and how similar to sincere, maximal efforts of injured people [15].
to interpret repeated trials have also been explored. The Hildreth proposed a rapid exchange test to detect
American Medical Association (AMA) Guides to the submaximal effort [20]. The test is performed by having the
th
Evaluation of Permanent Impairment, 5 edition, used in patient maximally grip the dynamometer, switching right to left
California and other states to determine disability, recommends hands, and comparing results with static tests. Hildreth et al.
3 measurements which are then averaged [9]. Coldham et al. stated that there is no set number of exchanges, but the testing
evaluated the reliability of one vs. three grip trials in continues until the examiner has determined if the results are
symptomatic and asymptomatic subjects using the Jamar positive or negative. A rapid exchange test score greater than
dynamometer [10]. Their findings suggest that one maximal the static test score is a negative result. A positive rapid
trial is as reliable as taking 3 measurements, either the best of 3 exchange test, one which, while not proof of “malingering” can
or the mean of 3 measurements. In contrast, Mathiowetz et al. “alert” and “sensitize” the physician to the possibility of
believed that the mean of 3 trials generated the highest submaximal effort. Like the 5 handle position grip test, the
reliability [11]. rapid exchange grip test has its critics [13]. Tredgett and Davis
stated that rapid, repeated measurement of grip strength could
So, from the above studies, when using the Jamar
not be relied on to discriminate between maximum effort and
dynamometer, one maximum grasp at setting 2 with the elbow
feigned hand weakness [14].
flexed at 90 degrees can provide a reliable measure of grip
strength. The AMA Guides to the Evaluation of Permanent
Impairment, 5th Edition, recommends both the rapid exchange
Submaximal effort during grip strength testing is an grip technique and the 5 handle setting technique to help detect
apparent popular topic in the literature. Various terms have less than maximal effort [9]. These methods are not foolproof.
been used to describe this scenario, such as “feigned hand Determining conclusively that one is not putting forth maximal
weakness,” “submaximal grip effort,” “faked hand weakness,” effort is difficult. Additionally, it should be noted that
“voluntary control of submaximal grip strength,” “sincerity of malingering is often considered a conscious or willful effort to
effort,” and “low effort” [12 - 17]. The words “malingering” “deceive,” and in the absence of some extraordinary proof, a
and “malingerers” also appear in the literature [18 - 20]. physician should use caution before labelling someone as a
In Bechtol’s 1954 report under a paragraph headed “failure malingerer.
to exert full effort during a grip test,” he described “repeated Normative data and demographic context are important
tests” as a basis for determining submaximal effort. According considerations when analyzing grip strength measurements and
to Bechtol, if a subject exerts full effort, scores on repeated their implications. A reference grip strength chart is available
tests will vary less than 20 percent and usually less than 10%. in the AMA Guides. Furthermore, Wang et al. have recently
With submaximal effort, repeated tests will vary greater than published normative reference values for grip strength for 1232
20% [1]. individuals of 18 to 85 years of age residing in the United
Afterward, other techniques have been tried in an attempt States (Table 1) [22]. The data were obtained from the United
to identify submaximal effort. Using the Jamar dynamometer, States National Institutes of Health Toolbox project and, as the
it has been observed that grip strength measurements obtained authors stated, can be used to interpret grip strength
at all 5 handle positions produced a bell-shaped curve, with measurements obtained from adults in the United States.

Table 1. Summary of hand-grip strength measurements by side, sex, and age-group strata.

- - Percentile
Hand/Sex/Age, years Strength, lb* 10 25 50 75 90
      Dominant: Male
18-24 (n = 36) 103.6 ± 17.9 79.8 91.3 105.4 112.9 127.6
25-29 (n = 35) 109.6 ± 25.6 74.3 95.5 108.7 131.0 145.9
30-34 (n = 29) 102.5 ± 26.7 68.8 80.2 101.6 124.3 139.1
35-39 (n = 41) 103.8 ± 26.2 66.8 87.5 110.5 119.7 134.0
40-44 (n = 47) 103.0 ± 25.8 75.6 88.0 101.2 119.9 139.1
45-49 (n = 32) 94.4 ± 24.0 68.6 78.9 89.7 106.3 130.5
50-54 (n = 46) 97.0 ± 22.7 67.0 86.0 98.8 115.3 125.0
55-59 (n = 27) 89.7 ± 22.9 62.2 71.4 85.3 105.4 124.1
A Review of Handgrip Strength The Open Orthopaedics Journal, 2022, Volume 16 5

(Table 1) contd.....
60-64 (n = 33) 84.7 ± 22.7 51.4 67.0 88.8 99.0 115.7
65-69 (n = 22) 81.1 ± 23.1 39.2 69.4 80.7 101.0 110.5
70-74 (n = 39) 76.5 ± 19.8 36.8 64.6 80.0 90.8 100.5
75-79 (n = 24) 72.1 ± 22.3 40.6 57.1 73.9 80.7 95.9
80-85 (n = 38) 61.9 ± 20.1 34.4 47.4 65.0 76.3 84.2
      Dominant: Female
18-24 (n = 54) 61.9 ± 15.7 38.8 49.4 62.6 74.5 83.8
25-29 (n = 102) 65.3 ± 15.4 44.5 56.0 65.3 74.1 87.5
30-34 (n = 109) 63.7 ± 13.7 45.2 52.7 65.7 72.8 81.8
35-39 (n = 90) 64.4 ± 13.7 44.1 54.0 66.8 72.8 83.8
40-44 (n = 88) 65.9 ± 13.7 50.3 58.4 67.0 74.5 82.5
45-49 (n = 52) 63.5 ± 15.9 39.0 55.6 63.3 75.8 82.9
50-54 (n = 65) 62.2 ± 13.9 43.4 54.2 62.2 72.1 77.6
55-59 (n = 30) 55.3 ± 13.7 37.3 45.6 53.1 66.6 71.0
60-64 (n = 58) 52.0 ± 14.3 35.1 42.3 53.8 61.9 70.1
65-69 (n = 29) 48.7 ± 14.6 25.8 42.5 48.9 55.1 68.8
70-74 (n = 43) 47.4 ± 11.2 33.5 43.0 49.6 52.7 60.6
75-79 (n = 17) 43.2 ± 13.2 27.8 34.6 40.1 49.4 61.3
80-85 (n = 46) 43.9 ± 9.7 32.0 36.6 43.0 48.1 59.5
      Nondominant: Male
18-24 (n = 36) 99.0 ± 17.2 78.7 83.8 98.1 111.1 121.7
25-29 (n = 35) 102.5 ± 21.2 68.6 86.9 104.1 124.3 132.1
30-34 (n = 29) 101.0 ± 24.9 62.8 81.6 99.2 123.9 132.5
35-39 (n = 41) 100.3 ± 24.3 75.6 82.7 104.1 115.3 129.6
40-44 (n = 47) 99.0 ± 25.8 70.8 85.5 94.1 115.5 135.4
45-49 (n = 32) 90.8 ± 22.0 65.3 75.8 89.1 102.5 127.2
50-54 (n = 46) 93.3 ± 23.4 59.7 84.4 97.7 107.4 121.5
55-59 (n = 27) 84.9 ± 21.2 60.4 67.7 82.0 93.7 121.9
60-64 (n = 33) 82.0 ± 20.1 51.6 70.3 81.8 98.8 108.7
65-69 (n = 22) 78.0 ± 22.7 38.1 61.7 82.7 94.8 105.8
70-74 (n = 39) 75.0 ± 20.9 45.2 65.9 76.1 89.5 100.8
75-79 (n = 24) 66.8 ± 21.8 32.0 54.0 66.6 79.4 88.6
80-85 (n = 38) 59.7 ± 20.7 31.3 44.1 60.2 70.5 88.2
      Nondominant: Female
18-24 (n = 54) 58.6 ± 14.1 44.1 48.1 54.5 68.3 82.9
25-29 (n = 102) 61.5 ± 14.6 45.0 52.2 60.6 70.1 84.2
30-34 (n = 109) 61.1 ± 13.0 43.2 53.1 60.8 67.9 77.6
35-39 (n = 90) 61.7 ± 13.2 43.4 52.2 60.8 70.5 80.2
40-44 (n = 88) 63.7 ± 14.1 47.8 55.6 64.6 74.1 81.1
45-49 (n = 52) 60.4 ± 15.4 37.7 50.3 59.3 73.6 80.5
50-54 (n = 65) 58.4 ± 14.3 39.0 49.2 58.2 70.3 76.7
55-59 (n = 30) 52.0 ± 14.1 32.2 40.6 51.8 62.2 68.6
60-64 (n = 58) 50.5 ± 13.9 34.8 38.8 49.8 62.2 67.5
65-69 (n = 29) 46.3 ± 14.6 33.1 35.7 47.2 56.9 67.5
70-74 (n = 43) 44.5 ± 12.1 30.2 36.8 46.1 51.8 61.7
75-79 (n = 17) 41.2 ± 12.8 23.6 31.7 41.0 48.5 60.4
80-85 (n = 46) 42.8 ± 8.8 30.6 38.1 42.5 46.3 54.0
*Values are mean ± Standard Deviation; lb = pounds.
Reprinted with permission from Wang YC, Bohannon RW, Li X, Sindhu B, Kapellusch J. Hand-grip strength: normative reference values and equations for individuals 18
to 85 years of age residing in the United States. J Orthop Sports Phys Ther. 2018;48:685-693. https://doi.org/10.2519/jospt.2018.7851. ©JOSPT®, Inc

Bechtol, in his 1954 paper, provided results of grip data, for handgrip strength has been studied in Australians,
strength testing in “unselected patients” with charts showing Spanish population, Greek population, Canadians aged 6-79
the distribution of grip strength in more than 400 men and years, South Korean population, 6 to 19-year-old individuals in
women [1]. Since then, and as noted by Wang et al., grip a 7 county Milwaukee area, “elderly Singaporeans,” “older
strength measurements, described as normative data, have been adults” in Singapore, Nepalese, Saudis, Iranian, and individuals
reported from all over the world [22]. For example, normative residing in the United States of 18 to 85 years of age [22 - 33].
6 The Open Orthopaedics Journal, 2022, Volume 16 Minasian et al.

Sometimes, it has been observed that the reference values will cause mortality in both men and women. Considering this
provide a basis for comparison when testing individuals [34]. finding, they concluded that assessing and monitoring handgrip
Often, no goal is given other than establishing reference values strength during adulthood protects against premature death in
or normative data. However, we can compare the grip strength the population of Korean adults [27].
measurement of one individual to a large group of similar
people. Mitsionis et al. believed that grip strength is a reliable Rantanen et al. investigated whether handgrip strength
way to assess the impact of an injury on the hands to evaluate measured during mid-life predicts old age functional
the effectiveness of the surgical intervention [25]. However, limitations and disability in initially healthy men. Their 25-year
comparing grip strength to the uninjured hand might be a better prospective cohort study involved more than 6,000, 45 to 68-
way. Generalizing from one group to another has been year-old Japanese-American men living in Hawaii. They found
questioned. For example, Werle et al. evaluated normative data that handgrip strength was highly predictive of functional
in a healthy adult Swiss population, found significant limitation and disability 25 years later. They surmised that
differences from other populations, and concluded that good muscle strength in middle age may protect people from
applying normative data internationally is “questionable” [35]. old age disability [39].
Ong et al. reported that older adults in Singapore had weaker
grip strength than older adults from Western and other Asian Giampaoli et al., in a population-based prospective study,
countries [30]. followed 140 Italian men aged 71 to 91 years who reported no
disability in performing activities of daily living. After four
Dodds et al., in 2016, reviewed studies on grip strength
years, their functional status was re-evaluated. Poor grip
from different countries. They performed a systematic review
strength predicted disability in men 77 years or older [40].
and meta-analysis of reports on grip strength throughout the
world (96, 517 grip strength observations). From their data, and In a longitudinal study conducted on Japanese men and
as one might expect, grip strength peaked between ages 20 to women, Sasaki found grip strength “an accurate and
40 years. One of their main findings was that grip strength consistent” predictor of all causes of mortality in middle-aged
measurements were substantially lower in developing world and elderly subjects [41].
regions, such as Africa, America (excluding North America),
and Asia (excluding Japan), compared to developed world Al Snih et al. evaluated the association between grip
regions. As a result, they questioned whether a single set of strength and mortality in older Mexican American men and
normative data could be used across different countries. women in a five-year prospective cohort study involving 2,488
Therefore, what constitutes low grip strength or weak grip may subjects aged 65 and older. In this study, it was found that
need different “cut points” for different geographic regions lower handgrip strength was a strong predictor of mortality
[36]. [42].
Moreover, as noted by Roberts et al., there is often Ling et al. performed a prospective population-based study
insufficient information about the protocols used in many on all 85-year-old inhabitants of Leiden, Netherland (total 555
studies which makes comparisons difficult [3]. participants). Handgrip strength was measured at baseline and
again at age of 89 years. They found, after adjusting for
2. GRIP STRENGTH AS A MEASURE OF HEALTH possible co-founders, a significant elevation in risk for all-
Orthopedic surgeons and hand surgeons often document cause mortality in subjects in the lowest tertile of handgrip
grip strength after injury or surgery. It is one way of strength at 85 years and the lowest two tertiles of handgrip
monitoring deficit, recovery, and return of functions. However, strength at age 89 years. Subjects with high relative loss of
perhaps unknown to most surgeons, grip strength is often used handgrip strength over 4 years also showed significantly
as a proxy for fitness and well-being, and a predictor of future increased mortality. It was reported that handgrip strength is a
health and mortality. surrogate measure of overall muscular strength. They
acknowledged that they could not determine whether the
Grip strength measurement is a tool to assess for relation between muscle strength and mortality is direct or
sarcopenia, which is a “progressive and generalized skeletal
whether muscular strength is a “surrogate marker” of other
disorder associated with increased likelihood of adverse
factors [43].
outcomes, including falls, fractures, physical disability, and
mortality” [37]. Sarcopenia is characterized by low muscle Lera et al., in a study on Chileans over 60 years, noted an
strength, low muscle quantity or quality, and low physical increased risk of all-cause mortality in subjects lower than the
performance. 25th percentile. As in other studies, they noted that they could
not discard the influence of other “nonmeasured parameters”
Gale et al., in 2007, investigated the relationship between
on the association between grip strength and mortality [44].
grip strength, body composition, and cause-specific and total
mortality in 800 men and women aged 65 and older living in Bohannon performed a literature review to assess the
Britain. They found that poor grip strength was associated with predictive value of grip strength. He found that low grip
increased mortality from all causes, cardiovascular disease, and strength was associated with a greater likelihood of premature
cancer in men, but not in women [38]. Grip strength, in their death. Additionally, low grip strength was associated with the
determination, is a long-term predictor of mortality in men. development of disability and an increased risk of
complications or prolonged length of stay after hospitalization
Bae et al. in a prospective observational study conducted in
or surgery [45].
Korea involving middle-aged and older adults, found a
relationship between weaker handgrip strength and higher all- Bohannon, in a recent and extensive review, described grip
A Review of Handgrip Strength The Open Orthopaedics Journal, 2022, Volume 16 7

strength as “an indispensable biomarker for older adults” and our primary care and geriatric colleagues, we can further
as “an explanator of concurrent overall strength, upper limb support our patients’ overall health, well-being, and potentially
function, bone mineral density, fractures, falls, malnutrition, even longevity.
cognitive impairment, depression, sleep problems, diabetes,
multimorbidity, and quality of life.” Also, Bohannon reported, CONSENT FOR PUBLICATION
“a predictive link between grip strength and all-cause and Not applicable.
disease-specific mortality” [46].
It should be noted that most of the studies that focused on FUNDING
grip strength and mortality have reported an association None.
without proving a causal relationship. However, one recent
study by McGrath et al. provided some support to suggest CONFLICT OF INTEREST
causality through a robust matched cohort study [47]. Their
The authors declare no conflict of interest, financial or
group evaluated grip strength and mortality in more than
otherwise.
19,000 Americans of at least 50 years old and divided them
into groups defined as weak, not weak, and strong. They ACKNOWLEDGEMENTS
defined weak grip as < 26 kg for men and < 16 kg for women.
They found a higher hazard for mortality in the weak cohort. Declared none.
Those in the weak cohort had a 40% and 54% greater risk for REFERENCES
early mortality relative to the not-weak and strong control
groups, respectively, despite these cohorts being balanced on [1] Bechtol CO. Grip test; the use of a dynamometer with adjustable
handle spacings. J Bone Joint Surg Am 1954; 36-A(4): 820-824,
modifiable and nonmodifiable factors associated with passim.
mortality. The authors stated that their findings “may indicate” [http://dx.doi.org/10.2106/00004623-195436040-00013] [PMID:
a causal association between muscle weakness and mortality 13174611]
[2] Bohannon RW, Bear-Lehman J, Desrosiers J, Massy-Westropp N,
[47].
Mathiowetz V. Average grip strength: A meta-analysis of data
Interestingly, in addition to association with overall obtained with a Jamar dynamometer from individuals 75 years or more
of age. J Geriatr Phys Ther 2007; 30(1): 28-30.
mortality, more recent studies have also demonstrated an [http://dx.doi.org/10.1519/00139143-200704000-00006] [PMID:
association between asymmetric handgrip strength and 19839178]
multimorbidity. Klawitter et al. studied handgrip strengths, [3] Roberts HC, Denison HJ, Martin HJ, et al. A review of the
measurement of grip strength in clinical and epidemiological studies:
which were asymmetric by >10% between dominant and non-
Towards a standardised approach. Age Ageing 2011; 40(4): 423-9.
dominant hands of individuals aged 40 years and greater [48]. [http://dx.doi.org/10.1093/ageing/afr051] [PMID: 21624928]
They found asymmetric handgrip strength to be linked to [4] Hogrel JY. Grip strength measured by high precision dynamometry in
chronic morbidity status, with these individuals demonstrating healthy subjects from 5 to 80 years. BMC Musculoskelet Disord 2015;
16(1): 139.
1.31 (95% confidence interval (CI): 1.03 – 1.67) greater odds [http://dx.doi.org/10.1186/s12891-015-0612-4] [PMID: 26055647]
for multimorbidity, as well as 1.22 (CI: 1.04 – 1.44) greater [5] Trampisch US, Franke J, Jedamzik N, Hinrichs T, Platen P. Optimal
odds for accumulating morbidities compared to individuals Jamar dynamometer handle position to assess maximal isometric hand
grip strength in epidemiological studies. J Hand Surg Am 2012;
without handgrip asymmetry. They suggested that healthcare 37(11): 2368-73.
providers encourage healthy, physically active behaviors, [http://dx.doi.org/10.1016/j.jhsa.2012.08.014] [PMID: 23101534]
which will reduce asymmetries, thus improving muscle [6] Firrell JC, Crain GM. Which setting of the dynamometer provides
maximal grip strength? J Hand Surg Am 1996; 21(3): 397-401.
function and mitigating morbidity risk in the future.
[http://dx.doi.org/10.1016/S0363-5023(96)80351-0] [PMID: 8724468]
Although causality cannot be proven by the currently [7] Mathiowetz V, Rennells C, Donahoe L. Effect of elbow position on
grip and key pinch strength. J Hand Surg Am 1985; 10(5): 694-7.
available literature, the robust body of evidence available [http://dx.doi.org/10.1016/S0363-5023(85)80210-0] [PMID: 4045150]
makes it clear that an important association exists between grip [8] Crosby CA, Wehbé MA, Mawr B. Hand strength: Normative values. J
strength and overall health. Hand Surg Am 1994; 19(4): 665-70.
[http://dx.doi.org/10.1016/0363-5023(94)90280-1] [PMID: 7963331]
[9] Cocchiarella L, Andersson GBJ. Guides to the evaluation of
CONCLUSION permanent impairment. 5th ed. American Medical Association 2001; p.
508.
Something seemingly so limited and circumscribed as grip
[10] Coldham F, Lewis J, Lee H. The reliability of one vs. three grip trials
strength measurement has significance beyond what many of in symptomatic and asymptomatic subjects. J Hand Ther 2006; 19(3):
us are aware. The evidence, almost all of which is not in the 318-26.
orthopedic literature, supports this simple objective test as [http://dx.doi.org/10.1197/j.jht.2006.04.002] [PMID: 16861131]
[11] Mathiowetz V, Weber K, Volland G, Kashman N. Reliability and
having value and usefulness beyond what most of us have validity of grip and pinch strength evaluations. J Hand Surg Am 1984;
known. Bohannon recommended routine grip strength 9(2): 222-6.
measurement for older adults in healthcare settings. Orthopedic [http://dx.doi.org/10.1016/S0363-5023(84)80146-X] [PMID:
6715829]
surgeons have the opportunity to measure grip strength as a
[12] Tredgett M, Pimble LJ, Davis TRC. The detection of feigned hand
routine part of an orthopedic examination and it is reasonable weakness using the five position grip strength test. J Hand Surg [Br]
to do so in order to identify at-risk patients who then can be 1999; 24(4): 426-8.
referred to primary care physicians and geriatricians for [http://dx.doi.org/10.1054/JHSB.1999.0205] [PMID: 10473149]
[13] Westbrook AP, Tredgett MW, Davis TR, Oni JA. The rapid exchange
additional evaluation and appropriate care. By utilizing this grip strength test and the detection of submaximal grip effort. J Hand
ubiquitous tool diligently and communicating these findings to Surg Am 2002; 27(2): 329-33.
8 The Open Orthopaedics Journal, 2022, Volume 16 Minasian et al.

[http://dx.doi.org/10.1053/jhsu.2002.30910] [PMID: 11901394] [http://dx.doi.org/10.4103/jfmpc.jfmpc_785_19] [PMID: 32110610]

[14] Tredgett MW, Davis TRC. Rapid repeat testing of grip strength for [32] Alqahtani B, Alenazi A, Alshehri M, Alqahtani M, Elnaggar R.
detection of faked hand weakness. J Hand Surg [Br] 2000; 25(4): Reference values and associated factors of hand grip strength in
372-5. elderly Saudi population: A cross-sectional study. BMC Geriatr 2019;
[http://dx.doi.org/10.1054/jhsb.2000.0433] [PMID: 11058007] 19(1): 271.
[15] Niebuhr BR, Marion R. Voluntary control of submaximal grip [http://dx.doi.org/10.1186/s12877-019-1288-7] [PMID: 31619169]
strength. Am J Phys Med Rehabil 1990; 69(2): 96-101. [33] Mohammadian M, Choobineh A, Haghdoost A, Hasheminejad N.
[http://dx.doi.org/10.1097/00002060-199004000-00010] [PMID: Normative data of grip and pinch strengths in healthy adults of Iranian
2331345] population. Iran J Public Health 2014; 43(8): 1113-22.
[16] Niebuhr BR, Marion R. Detecting sincerity of effort when measuring [PMID: 25927041]
grip strength. Am J Phys Med 1987; 66(1): 16-24. [34] Wang YC, Bohannon RW, Li X, Yen SC, Sindhu B, Kapellusch J.
[PMID: 3826325] Summary of grip strength measurements obtained in the 2011-2012
[17] Stokes HM, Landrieu KW, Domangue B, Kunen S. Identification of and 2013-2014 National Health and Nutrition Examination Surveys. J
low-effort patients through dynamometry. J Hand Surg Am 1995; Hand Ther 2019; 32(4): 489-96.
20(6): 1047-56. [http://dx.doi.org/10.1016/j.jht.2018.03.002] [PMID: 29653890]
[http://dx.doi.org/10.1016/S0363-5023(05)80158-3] [PMID: 8583056] [35] Werle S, Goldhahn J, Drerup S, Simmen BR, Sprott H, Herren DB.
Age- and gender-specific normative data of grip and pinch strength in
[18] Ghori AK, Chung KC. A decision-analysis model to diagnose feigned
a healthy adult Swiss population. J Hand Surg Eur Vol 2009; 34(1):
hand weakness. J Hand Surg Am 2007; 32(10): 1638-43.
76-84.
[http://dx.doi.org/10.1016/j.jhsa.2007.09.010] [PMID: 18070655]
[http://dx.doi.org/10.1177/1753193408096763] [PMID: 19129352]
[19] Stokes HM. The seriously uninjured hand--weakness of grip. J Occup
[36] Dodds RM, Syddall HE, Cooper R, Kuh D, Cooper C, Sayer AA.
Med 1983; 25(9): 683-4.
Global variation in grip strength: A systematic review and meta-
[http://dx.doi.org/10.1097/00043764-198309000-00017] [PMID:
analysis of normative data. Age Ageing 2016; 45(2): 209-16.
6631568]
[http://dx.doi.org/10.1093/ageing/afv192] [PMID: 26790455]
[20] Hildreth DH, Breidenbach WC, Lister GD, Hodges AD. Detection of
[37] Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: Revised
submaximal effort by use of the rapid exchange grip. J Hand Surg Am
European consensus on definition and diagnosis. Age Ageing 2019;
1989; 14(4): 742-5.
48(1): 16-31.
[http://dx.doi.org/10.1016/0363-5023(89)90204-9] [PMID: 2526835]
[http://dx.doi.org/10.1093/ageing/afy169] [PMID: 30312372]
[21] Shechtman O, Gutierrez Z, Kokendofer E. Analysis of the statistical
[38] Gale CR, Martyn CN, Cooper C, Sayer AA. Grip strength, body
methods used to detect submaximal effort with the five-rung grip
composition, and mortality. Int J Epidemiol 2007; 36(1): 228-35.
strength test. J Hand Ther 2005; 18(1): 10-8.
[http://dx.doi.org/10.1093/ije/dyl224] [PMID: 17056604]
[http://dx.doi.org/10.1197/j.jht.2004.10.004] [PMID: 15674782]
[39] Rantanen T, Guralnik JM, Foley D, et al. Midlife hand grip strength as
[22] Wang YC, Bohannon RW, Li X, Sindhu B, Kapellusch J. Hand-grip
a predictor of old age disability. JAMA 1999; 281(6): 558-60.
strength: Normative reference values and equations for individuals 18
[http://dx.doi.org/10.1001/jama.281.6.558] [PMID: 10022113]
to 85 years of age residing in the united states. J Orthop Sports Phys
[40] Giampaoli S, Ferrucci L, Cecchi F, et al. Hand-grip strength predicts
Ther 2018; 48(9): 685-93. incident disability in non-disabled older men. Age Ageing 1999; 28(3):
[http://dx.doi.org/10.2519/jospt.2018.7851] [PMID: 29792107] 283-8.
[23] Massy-Westropp NM, Gill TK, Taylor AW, Bohannon RW, Hill CL. [http://dx.doi.org/10.1093/ageing/28.3.283] [PMID: 10475865]
Hand Grip Strength: age and gender stratified normative data in a [41] Sasaki H, Kasagi F, Yamada M, Fujita S. Grip strength predicts cause-
population-based study. BMC Res Notes 2011; 4(1): 127. specific mortality in middle-aged and elderly persons. Am J Med
[http://dx.doi.org/10.1186/1756-0500-4-127] [PMID: 21492469] 2007; 120(4): 337-42.
[24] Sánchez Torralvo FJ, Porras N, Abuín Fernández J, et al. Normative [http://dx.doi.org/10.1016/j.amjmed.2006.04.018] [PMID: 17398228]
reference values for hand grip dynamometry in Spain. Association [42] Al Snih S, Markides KS, Ray L, Ostir GV, Goodwin JS. Handgrip
with lean mass. Nutr Hosp 2018; 35(1): 98-103. strength and mortality in older Mexican Americans. J Am Geriatr Soc
[http://dx.doi.org/10.20960/nh.1052] [PMID: 29565156] 2002; 50(7): 1250-6.
[25] Mitsionis G, Pakos EE, Stafilas KS, Paschos N, Papakostas T, Beris [http://dx.doi.org/10.1046/j.1532-5415.2002.50312.x] [PMID:
AE. Normative data on hand grip strength in a Greek adult population. 12133020]
Int Orthop 2009; 33(3): 713-7. [43] Ling CH, Taekema D, de Craen AJ, Gussekloo J, Westendorp RG,
[http://dx.doi.org/10.1007/s00264-008-0551-x] [PMID: 18414855] Maier AB. Handgrip strength and mortality in the oldest old
[26] Wong SL. Grip strength reference values for Canadians aged 6 to 79: population: The Leiden 85-plus study. CMAJ 2010; 182(5): 429-35.
Canadian Health Measures Survey, 2007 to 2013. Health Rep 2016; [http://dx.doi.org/10.1503/cmaj.091278] [PMID: 20142372]
27(10): 3-10. [44] Lera L, Albala C, Leyton B, et al. Reference values of hand-grip
[PMID: 27759870] dynamometry and the relationship between low strength and mortality
[27] Bae EJ, Park NJ, Sohn HS, Kim YH. Handgrip strength and all-cause in older Chileans. Clin Interv Aging 2018; 13: 317-24.
mortality in middle-aged and older koreans. Int J Environ Res Public [http://dx.doi.org/10.2147/CIA.S152946] [PMID: 29503536]
Health 2019; 16(5): 740. [45] Bohannon RW. Hand-grip dynamometry predicts future outcomes in
[http://dx.doi.org/10.3390/ijerph16050740] [PMID: 30823660] aging adults. J Geriatr Phys Ther 2008; 31(1): 3-10.
[28] Mathiowetz V, Wiemer DM, Federman SM. Grip and pinch strength: [http://dx.doi.org/10.1519/00139143-200831010-00002] [PMID:
Norms for 6- to 19-year-olds. Am J Occup Ther 1986; 40(10): 705-11. 18489802]
[http://dx.doi.org/10.5014/ajot.40.10.705] [PMID: 3777107] [46] Bohannon RW. Grip strength: An indispensable biomarker for older
[29] Malhotra R, Ang S, Allen JC, et al. Normative values of hand grip adults. Clin Interv Aging 2019; 14: 1681-91.
strength for elderly singaporeans aged 60 to 89 years: A cross- [http://dx.doi.org/10.2147/CIA.S194543] [PMID: 31631989]
sectional study. J Am Med Dir Assoc 2016; 17(9): 864.e1-7. [47] McGrath R, Vincent BM, Peterson MD, et al. Weakness may have a
[http://dx.doi.org/10.1016/j.jamda.2016.06.013] [PMID: 27569714] causal association with early mortality in older americans: A matched
[30] Ong HL, Abdin E, Chua BY, et al. Hand-grip strength among older cohort analysis. J Am Med Dir Assoc 2020; 21(5): 621-626.e2.
adults in Singapore: A comparison with international norms and [http://dx.doi.org/10.1016/j.jamda.2019.10.016] [PMID: 31786197]
associative factors. BMC Geriatr 2017; 17(1): 176. [48] Klawitter L, Bradley A, Hackney KJ, et al. The associations between
[http://dx.doi.org/10.1186/s12877-017-0565-6] [PMID: 28778190] asymmetric handgrip strength and chronic disease status in american
[31] Bimali I, Opsana R, Jeebika S. Normative reference values on adults: results from the national health and nutrition examination
handgrip strength among healthy adults of Dhulikhel, Nepal: A cross- survey. J Funct Morphol Kinesiol 2021; 6(4): 79.
sectional study. J Family Med Prim Care 2020; 9(1): 310-4. [http://dx.doi.org/10.3390/jfmk6040079] [PMID: 34698229]

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