Research: hand and arm strength in MS

R
Guclu-Gunduz et al. Upper extremity function and its relation with hand sensation and upper extremity strength in patients with multiple sclerosis.NeuroRehabilitation. 2012 ;30(4):369-74.

Objective: The purpose of this study was to investigate the relationships between the upper extremity functions, upper extremity strength and hand sensation in MSers. 


Methods: 22 MSers (mean age: 38.5 ± 8.31 years, median EDSS = 2) and 10 healthy subjects were included. Upper extremity function was measured with the 9-hole peg test, upper extremity strength (shoulder flexion-abduction, elbow flexion, pinch and grip) with hand-held dynamometer (strength meter), hand grip dynamometer and manual pinch meter, threshold of light touch-pressure with Semmes-Weinstein monofilament, duration of vibration with 128-Hz frequency tuning fork, and distance of two-point discrimination with an aesthesiometer. 

Results: Strength and functional level of the upper extremity, light touch-pressure, two-point discrimination, vibration sensations of the hand were lower in MSers compared with healthy controls (p < 0.05). Light touch-pressure sensation of thumb and index fingers, two-point discrimination of index finger and elbow flexion strength were found to be related with upper extremity function in MSers (p< 0.05). 
Handgrip Dynamometer
Conclusions: These results indicate that the hand sensation, upper extremity strength and function were affected in MSers. Additionally upper extremity functions seem to be related with light touch-pressure and two-point discrimination sensations of the hand and elbow flexion strength. Upper extremity strengthening and sensorial training of the hand may contribute to the upper extremity function in MSers.

“These results show that even in MSers with early disease, i.e. minimal disability with an EDSS of 2.0, there is involvement of the upper limbs. Most MSers would not notice this disability as it is very mild and would only show up with sensitive tests. Another cause of some of these abnormalities is de-conditioning that occurs as a result of becoming ‘relatively inactive’.”

“Are you aware of any upper limb problems?”


Semmes-Weinstein monofilament Test

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

5 comments

  • For a lot of MSers a wheelchair seems to be a big problem.
    But at least you have a device which can help you around.
    If your arms or hands are effected there is no help.
    I have weak arms and hands and no ability to use force and precision with my hands.
    To write this comment is a quite a task.

  • Yes – I have weakness in both arms, neuropathic pain in my right arm, intermittent tremors in my thumbs and very little sensation in my fingertips. The latter makes reliably holding small things difficult.

    People generally don't have any understanding of these sort of issues and I get lots of dirty looks / comments in shops as it is tricky to pack shopping, pay with cards or coins and take change.

  • No joke, although my MS is mainly a lower limb issue, my hands are progressively getting worse. My fingers are always numb so doing things like typing is becoming harder. Yesterday I was having dinner at my parents house and was struggling to grip my fork. It upset me so much that I didn't want to complete my meal.

    What's weird is that I went to the gym today and was lifing pretty heavy weights with not too much in the way of problems, yet as I'm typing this comment my fingers are growing tired.

    MS is the most stranget disease. Simple things are hard but things others may struggle with I can still do like lift weights, in a seated position of course.

  • Hand problems are scary because they make you helpless. There is nothing you can use in place of hands. My daughter (a student) can't write and even typing is becoming harder. Shoelaces, nail clippers, buttons, knives and forks, … all are hard or impossible.
    Other symptoms may come and go but the hand tremors and incoordination dont go

  • I don't have as many problems as some of the above posters, but I am scared by the problems I do have with my hands.

    I am grateful to live in the credit card era as I dread having to pay for things with cash. I'm slower than little old ladies, fumble with money and have an unfortunate tendency to drop things without noticing that I've done so. This is especially disturbing if the thing dropped is a twenty dollar bill.

    I am also thankful to live in the computer era. My handwriting, never good, has become increasingly illegible even to me and I have endurance problems with writing. My typing is neither as fast nor as accurate as it once was, but it's functional. It's not helped by the fact that I seem to have forgotten how to spell and I now make all sorts of bizarre mistakes (some can be blamed on autocorrect run amok but some are just inexplicable where I seem to have typed a completely unrelated word in the middle of an otherwise sensical sentence). For a while I had this problem where I would hit the windows key when I meant to hit shift, which caused my computer to suddenly do all sorts of unexpected and unwanted things. Fortunately, my pinkie seems to have reeducated itself out of that habit.

    I can't do anything that requires fine eye-hand coordination or small, accurate movements. I have trouble even picking up pills that have dropped on the floor.

    My strength is not what it once was. I used to be able to open jars just fine, but now I usually have to call on my husband. I generally cannot open the kind of bags that potato chips come in. I have to resort to scissors.

    I can't do anything with my hands that I can't see. @Prof G I hope you don't have those doctor's office gowns that tie in the back in your exam rooms. The only thing I've figured out to do with those is put them on backwards, tie them in the front and wiggle them around to the way they're supposed to be. I also have trouble with finding things in my pocket or purse when I can't see them. I am forever pulling out my work keys when I want the house keys and vice versa or thinking I have lost something that really is there.

    I also find that I favor my right hand as it works better. The left seems more numb and less coordinated, although it also might be that I am right-handed. I have good intentions to force myself to use the left more (sort of like that constraint-induced therapy for strokes https://en.wikipedia.org/wiki/Constraint-induced_movement_therapy), but fail on follow through.

    I have wild (and probably unrealistic) hopes for all the work with using sensors in the brain to bypass the spinal cord. They've even enabled a monkey to both move and touch things with an artificial arm, which they hope could work with some sort of exoskeleton for people (http://www.guardian.co.uk/science/2011/oct/05/monkeys-mind-control-virtual-arm, http://www.scientificamerican.com/article.cfm?id=cant-touch-this-feeling). How I would love to be able to really feel things again. I guess it's a ways off, though (http://www.wired.com/wiredscience/2012/03/ff_prosthetics/all/1) and I hate to think how much they'll charge. And would these things even work in MS when the brain continues to deteriorate?

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