Hand Function Often Overlooked in MS Work-Up

Published: June 02, 2012

Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco.

SAN DIEGO — Impairments in hand function are common in multiple sclerosis (MS) patients and are a significant quality of life issue, yet they are not routinely evaluated in clinical work-ups, a researcher said here.

Half of patients with progressive MS took at least twice as long to complete the standard nine-hole peg test compared with healthy controls, and one-third had less than 50% of expected grip and pinch strength, reported Gloria von Geldern, MD, of Johns Hopkins University.

But the usual symptom-assessment scales used to evaluate MS patients focus on lower-body issues such as gait and mobility, von Geldern said at the joint meeting of the Consortium of Multiple Sclerosis Centers and the Americas Committee for Treatment and Research in Multiple Sclerosis. Problems with hand strength and dexterity are not included.

And, importantly, the study showed that impairment in hand function is not strongly correlated with lower-body disability as measured with hip strength or the 25-foot timed walk.

Von Geldern and colleagues recruited 147 MS patients and 35 healthy volunteers for the study. Mean Expanded Disabilities Status Scale (EDSS) score was 3.6 (SD 2.2) for the patients, of whom 82 had relapsing MS and 59 had progressive disease.

Four tests of hand function were administered: grip strength, pinch strength, finger tapping, and the nine-hole peg test. Results were adjusted for age and gender.

Findings in patients with nonprogressive relapsing disease were generally similar to those in controls. Many patients with progressive disease, however, had clear impairments in all four measures of hand function:

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