Rheumatology International

, Volume 38, Issue 5, pp 707–714 | Cite as

Measuring hand grip strength in rheumatoid arthritis

  • Susie C. Higgins
  • Jo Adams
  • Rodney Hughes
Expert Opinion


Rheumatoid arthritis (RA) is a systemic inflammatory disease with a particular predilection for causing pain, deformity and functional limitation affecting the hands. Measures of the severity of RA, such as the disease activity score with 28 joint count may not fully reflect the regional impact of RA on the hands. Hand grip strength measurements are a form of objective assessment that focuses specifically on the hands in RA. This review explores what is currently known about the assessment of hand grip strength; what it may indicate, how it is measured, some of the practical aspects and challenges associated with performing these tests, and how this information can be applied in a clinical setting. It summarises the role that grip strength has in assessing patients with RA and finishes with some recommendations for how to use grip strength measurements in clinical practice, and what direction future research might take.


Rheumatoid arthritis Hand strength Equipment design Clinical protocols Disease progression Physical examination Rehabilitation Monitoring Physiological 


Author contributions

Dr SCH carried out the literature review and wrote the original article, with significant editorial input and correction by Professor JA and Dr RH.


No financial support was received in the preparation of this article.

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Grassi W, De Angelis R, Lamanna G, Cervini C (1998) The clinical features of rheumatoid arthritis. Eur J Radiol 27(Suppl 1):S18–S24CrossRefPubMedGoogle Scholar
  2. 2.
    Towheed TE, Anastassiades TP (1994) Rheumatoid hand. Practical approach to assessment and management. Can Fam Physician 40:1303–1309PubMedPubMedCentralGoogle Scholar
  3. 3.
    Eberhardt K, Sandqvist G, Geborek P (2008) Hand function tests are important and sensitive tools for assessment of treatment response in patients with rheumatoid arthritis. Scand J Rheumatol 37(2):109–112CrossRefPubMedGoogle Scholar
  4. 4.
    Vliet Vlieland TP, van der Wijk TP, Jolie IM, Zwinderman AH, Hazes JM (1996) Determinants of hand function in patients with rheumatoid arthritis. J Rheumatol 23(5):835–840PubMedGoogle Scholar
  5. 5.
    Bodur H, Yilmaz O, Keskin D (2006) Hand disability and related variables in patients with rheumatoid arthritis. Rheumatol Int 26(6):541–544CrossRefPubMedGoogle Scholar
  6. 6.
    Gasparyan AY, Ayvazyan L, Blackmore H, Kitas GD (2011) Writing a narrative biomedical review: considerations for authors, peer reviewers, and editors. Rheumatol Int 31(11):1409–1417CrossRefPubMedGoogle Scholar
  7. 7.
    Bohannon R (2002) Quantitative testing of muscle strength: issues and practical options for the geriatric population. Topics Geriatr Rehabil 18(2):1–17CrossRefGoogle Scholar
  8. 8.
    Napier JR (1956) The prehensile movements of the human hand. J Bone Jt Surg Br 38-B(4):902–913CrossRefGoogle Scholar
  9. 9.
    Roberts HC, Denison HJ, Martin HJ, Patel HP, Syddall H, Cooper C et al (2011) A review of the measurement of grip strength in clinical and epidemiological studies: towards a standardised approach. Age Ageing 40(4):423–429CrossRefPubMedGoogle Scholar
  10. 10.
    Shiratori AP, Iop RAR, Borges Júnior NG, Domenech SC, Gevaerd MaS (2014) Evaluation protocols of hand grip strength in individuals with rheumatoid arthritis: a systematic review. Rev Bras Reumatol 54(2):140–147CrossRefPubMedGoogle Scholar
  11. 11.
    Mathiowetz V (2002) Comparison of Rolyan and Jamar dynamometers for measuring grip strength. Occup Ther Int 9(3):201–209CrossRefPubMedGoogle Scholar
  12. 12.
    Svens B, Lee H (2005) Intra- and inter-instrument reliability of grip-strength measurements: GripTrackTM and Jamar® hand dynamometers. Br J Hand Ther 10(2):47–55CrossRefGoogle Scholar
  13. 13.
    Ward C, Adams J (2007) Comparative study of the test–re-test reliability of four instruments to measure grip strength in a healthy population. Br J Hand Ther 12:48–54CrossRefGoogle Scholar
  14. 14.
    Mathiowetz V, Weber K, Volland G, Kashman N (1984) Reliability and validity of grip and pinch strength evaluations. J Hand Surg Am 9(2):222–226CrossRefPubMedGoogle Scholar
  15. 15.
    Blenkiron EL (2005) Uptake of standardised hand assessments in rheumatology: why is it so low? Br J Occup Ther 68(4):148–157CrossRefGoogle Scholar
  16. 16.
    Agnew P, Maas F (1991) Jamar dynamometer and adapted sphygmomanometer for measuring grip strength in patients with rheumatoid arthritis. Occup Particip Health 11(5):259–270Google Scholar
  17. 17.
    Hogrel JY (2015) Grip strength measured by high precision dynamometry in healthy subjects from 5 to 80 years. BMC Musculoskelet Disord 16:139CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Sipers WM, Verdijk LB, Sipers SJ, Schols JM, van Loon LJ (2016) The Martin vigorimeter represents a reliable and more practical tool than the Jamar dynamometer to assess handgrip strength in the geriatric patient. J Am Med Dir Assoc 17(5):466.e1–e7CrossRefGoogle Scholar
  19. 19.
    Adams J, Burridge J, Mullee M, Hammond A, Cooper C (2008) The clinical effectiveness of static resting splints in early rheumatoid arthritis: a randomized controlled trial. Rheumatology 47(10):1548–1553CrossRefPubMedGoogle Scholar
  20. 20.
    Haidar SG, Kumar D, Bassi RS, Deshmukh SC (2004) Average versus maximum grip strength: which is more consistent? J Hand Surg Br 29(1):82–84CrossRefPubMedGoogle Scholar
  21. 21.
    Kennedy D, Jerosch-Herold C, Hickson M (2010) The reliability of one vs. three trials of pain-free grip strength in subjects with rheumatoid arthritis. J Hand Ther 23(4):384–390 (quiz 91) CrossRefPubMedGoogle Scholar
  22. 22.
    Helliwell P, Howe A, Wright V (1987) Functional assessment of the hand: reproducibility, acceptability, and utility of a new system for measuring strength. Ann Rheum Dis 46(3):203–208CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Richards LG, Olson B, Palmiter-Thomas P (1996) How forearm position affects grip strength. Am J Occup Ther 50(2):133–138CrossRefPubMedGoogle Scholar
  24. 24.
    Mathiowetz V, Candidate P (1991) Reliability and validity of grip and pinch strength measurements. Crit Rev Phys Rehabil Med 2.4:201–202Google Scholar
  25. 25.
    Häkkinen A, Sokka T, Kotaniemi A, Hannonen P (2001) A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity, and bone mineral density in early rheumatoid arthritis. Arthritis Rheum 44(3):515–522CrossRefPubMedGoogle Scholar
  26. 26.
    Dias JJ, Singh HP, Taub N, Thompson J (2013) Grip strength characteristics using force–time curves in rheumatoid hands. J Hand Surg Eur 38(2):170–177CrossRefGoogle Scholar
  27. 27.
    Günther CM, Bürger A, Rickert M, Crispin A, Schulz CU (2008) Grip strength in healthy caucasian adults: reference values. J Hand Surg Am 33(4):558–565CrossRefPubMedGoogle Scholar
  28. 28.
    Myers DB, Grennan DM, Palmer DG (1980) Hand grip function in patients with rheumatoid arthritis. Arch Phys Med Rehabil 61(8):369–373PubMedGoogle Scholar
  29. 29.
    Spruit MA, Sillen MJ, Groenen MT, Wouters EF, Franssen FM (2013) New normative values for handgrip strength: results from the UK Biobank. J Am Med Dir Assoc 14(10):775.e5–e11CrossRefGoogle Scholar
  30. 30.
    Nordenskiöld UM, Grimby G (1993) Grip force in patients with rheumatoid arthritis and fibromyalgia and in healthy subjects. A study with the Grippit instrument. Scand J Rheumatol 22(1):14–19CrossRefPubMedGoogle Scholar
  31. 31.
    Fraser A, Vallow J, Preston A, Cooper RG (1999) Predicting ‘normal’ grip strength for rheumatoid arthritis patients. Rheumatology 38(6):521–528CrossRefPubMedGoogle Scholar
  32. 32.
    Thyberg I, Dahlström Ö, Björk M, Stenström B, Adams J (2016) Hand pains in women and men in early rheumatoid arthritis, a one year follow-up after diagnosis. The Swedish TIRA project. Disabil Rehabil:1–10Google Scholar
  33. 33.
    Su CY, Lin JH, Chien TH, Cheng KF, Sung YT (1994) Grip strength in different positions of elbow and shoulder. Arch Phys Med Rehabil 75(7):812–815PubMedGoogle Scholar
  34. 34.
    Coldham F, Lewis J, Lee H (2006) The reliability of one vs. three grip trials in symptomatic and asymptomatic subjects. J Hand Ther 19(3):318–326 (quiz 27) CrossRefPubMedGoogle Scholar
  35. 35.
    Lagerström C, Nordgren B (1998) On the reliability and usefulness of methods for grip strength measurement. Scand J Rehabil Med 30(2):113–119CrossRefPubMedGoogle Scholar
  36. 36.
    Nitschke JE, McMeeken JM, Burry HC, Matyas TA (1999) When is a change a genuine change? A clinically meaningful interpretation of grip strength measurements in healthy and disabled women. J Hand Ther 12(1):25–30CrossRefPubMedGoogle Scholar
  37. 37.
    Niedermann K, Buchi S, Ciurea A, Kubli R, Steurer-Stey C, Villiger PM et al (2012) Six and 12 months’ effects of individual joint protection education in people with rheumatoid arthritis: a randomized controlled trial. Scand J Occup Ther 19(4):360–369CrossRefPubMedGoogle Scholar
  38. 38.
    Williams MA, Williamson EM, Heine PJ, Nichols V, Glover MJ, Dritsaki M et al (2015) Strengthening and stretching for rheumatoid arthritis of the hand (SARAH). A randomised controlled trial and economic evaluation. Health Technol Assess 19(19):1–222CrossRefGoogle Scholar
  39. 39.
    Jacobs JW, Geenen R, Evers AW, van Jaarsveld CH, Kraaimaat FW, Bijlsma JW (2001) Short term effects of corticosteroid pulse treatment on disease activity and the wellbeing of patients with active rheumatoid arthritis. Ann Rheum Dis 60(1):61–64CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Sheehy C, Gaffney K, Mukhtyar C (2013) Standardized grip strength as an outcome measure in early rheumatoid arthritis. Scand J Rheumatol 42(4):289–293CrossRefPubMedGoogle Scholar
  41. 41.
    Alley DE, Shardell MD, Peters KW, McLean RR, Dam TT, Kenny AM et al (2014) Grip strength cutpoints for the identification of clinically relevant weakness. J Gerontol A Biol Sci Med Sci 69(5):559–566CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Tyler H, Adams J, Ellis B (2005) What can handgrip strength tell the therapist about hand function? Br J Hand Ther 10(1):4–9CrossRefGoogle Scholar
  43. 43.
    Dedeoglu M, Gafuroglu Ü, Yilmaz Ö, Bodur H (2013) The relationship between hand grip and pinch strengths and disease activity, articular damage, pain, and disability in patients with rheumatoid arthritis. Arch Rheumatol 28(2):69–77Google Scholar
  44. 44.
    Escalante A, Haas RW, del Rincón I (2004) Measurement of global functional performance in patients with rheumatoid arthritis using rheumatology function tests. Arthritis Res Ther 6(4):R315–R325CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Jones E, Hanly JG, Mooney R, Rand LL, Spurway PM, Eastwood BJ et al (1991) Strength and function in the normal and rheumatoid hand. J Rheumatol 18(9):1313–1318PubMedGoogle Scholar
  46. 46.
    Björk MA, Thyberg IS, Skogh T, Gerdle BU (2007) Hand function and activity limitation according to health assessment questionnaire in patients with rheumatoid arthritis and healthy referents: 5-year followup of predictors of activity limitation (The Swedish TIRA Project). J Rheumatol 34(2):296–302PubMedGoogle Scholar
  47. 47.
    Özeri Z, Çakýt BD, Taþkýn S, Genç H, Saraçoðlu M, Erdem HR (2008) The relationships among functional impairment, disability and articular damage in rheumatoid hand. J Phys Med Rehabil Sci 2:53–58Google Scholar
  48. 48.
    Bombardier C, Barbieri M, Parthan A, Zack DJ, Walker V, Macarios D et al (2012) The relationship between joint damage and functional disability in rheumatoid arthritis: a systematic review. Ann Rheum Dis 71(6):836–844CrossRefPubMedGoogle Scholar
  49. 49.
    Navarro-Compán V, Landewé R, Provan SA, Ødegård S, Uhlig T, Kvien TK et al (2015) Relationship between types of radiographic damage and disability in patients with rheumatoid arthritis in the EURIDISS cohort: a longitudinal study. Rheumatology 54(1):83–90CrossRefPubMedGoogle Scholar
  50. 50.
    Arvidson NG, Larsson A, Larsen A (2002) Simple function tests, but not the modified HAQ, correlate with radiological joint damage in rheumatoid arthritis. Scand J Rheumatol 31(3):146–150CrossRefPubMedGoogle Scholar
  51. 51.
    Teo K, Chow CK, Vaz M, Rangarajan S, Yusuf S, Group PI-W (2009) The Prospective Urban Rural Epidemiology (PURE) study: examining the impact of societal influences on chronic noncommunicable diseases in low-, middle-, and high-income countries. Am Heart J 158(1):1–7.e1CrossRefPubMedGoogle Scholar
  52. 52.
    Leong DP, Teo KK, Rangarajan S, Lopez-Jaramillo P, Avezum A, Orlandini A et al (2015) Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study. Lancet 386(9990):266–273CrossRefPubMedGoogle Scholar
  53. 53.
    Schumacher HR, Habre W, Meador R, Hsia EC (2004) Predictive factors in early arthritis: long-term follow-up. Semin Arthritis Rheum 33(4):264–272CrossRefPubMedGoogle Scholar
  54. 54.
    Corbett M, Dalton S, Young A, Silman A, Shipley M (1993) Factors predicting death, survival and functional outcome in a prospective study of early rheumatoid disease over fifteen years. Br J Rheumatol 32(8):717–723CrossRefPubMedGoogle Scholar
  55. 55.
    Callahan LF, Pincus T, Huston JW, Brooks RH, Nance EP, Kaye JJ (1997) Measures of activity and damage in rheumatoid arthritis: depiction of changes and prediction of mortality over five years. Arthritis Care Res 10(6):381–394CrossRefPubMedGoogle Scholar
  56. 56.
    Flipon E, Brazier M, Clavel G, Boumier P, Gayet A, Le Loët X et al (2009) Is it possible to identify early predictors of the future cost of chronic arthritis? The VErA project. Fundam Clin Pharmacol 23(1):105–113CrossRefPubMedGoogle Scholar
  57. 57.
    Ibrahim K, May C, Patel HP, Baxter M, Sayer AA, Roberts H (2016) A feasibility study of implementing grip strength measurement into routine hospital practice (GRImP): study protocol. Pilot Feasibil Stud 2:27CrossRefGoogle Scholar
  58. 58.
    Taştekin N, Uzunca K, Birtane M, Kabayel DD, Öztürk G (2006) The relationship of range of motion and grip strength of the hand with disease activity, hand functions and disability in patients with rheumatoid arthritis. Arch Rheumatol 21(1):13–17Google Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Rheumatology, Maidstone and Tunbridge Wells NHS TrustMaidstone HospitalMaidstoneUK
  2. 2.Faculty of Health SciencesUniversity of SouthamptonSouthamptonUK
  3. 3.Department of Rheumatology, Ashford and St Peter’s Hospitals NHS Foundation TrustSt Peter’s HospitalChertseyUK

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