ORIGINAL PAPERNormative data on hand grip strength in a Greekadult populationGregory Mitsionis & Emilios E. Pakos &Kosmas S. Stafilas & Nikolaos Paschos &Theodore Papakostas & Alexandros E. BerisReceived: 29 November 2007 / Revised: 5 January 2008 / Accepted: 15 February 2008 / Published online: 15 April 2008# Springer-Verlag 2008Abstract The objectives of this study were to establish dataconcerningnormal handgripstrength(GS)andtoexplorepossible associations withanthropometric parameters. GSwas measured in 232 individuals in a standard arm positionusing the Jamar dynamometer. We examined differencesbetween right/left and dominant/nondominant hands. Possiblecorrelations of GS with anthropometric values were evaluat-ed. Right handanddominant handGSwerefoundtobehigher and statistically significant compared to left hand andnondominant hand GS, respectively. Men had higher valuesof GScompared to women. Anegative association wasobservedbetweenageanddominant handGS. Apositiveassociationwasdocumentedbetweenheight anddominanthandGS, whiletherespectivecomparisonfor weight anddominant hand GS documented a statistically significantpositive association only in the male group. ApositiveassociationbetweenBMIanddominanthandGSwasseenin female individuals. Additional factors associated with GSshould be the goal of future investigations.Rsum Etablir des donnes concernant la force de serragede la main (GS) et, explorer les possibles associations avecdes paramtres anthropomtriques. La force de la main: GSatmesurechez232individusenpositionstandarddubras, utilisant le dynamomtre de Jamar. Nous avonsexaminlesdiffrencesentrelesctsdroit et gaucheetdominant/non-dominant. LespossiblescorrlationsdeGSavec des valeurs anthropomtriques ont t values.Respectivement maindroiteet GSductdominant ontt retrouves de manire significativement plus leve quemain gauche et GS non-dominant. Les hommes avaient desvaleurs de GS plus leves que les femmes. Une associationngativeatretrouveentrelgeet laGSdelamaindominante. Une association positive a t documente entrela taille et la GS du ct dominant, tandis que lacomparaison entre le poids et la GS du ct dominantmontreune associationpositivede manire statistiquementsignificative, uniquement dans le groupe des hommes. Uneassociation positive a t retrouve entre le BMI et la GS duct dominant dans le groupe des femmes. Des facteursadditionnels associs avec la GS devraient tre le but dunefuture investigation.IntroductionThe evaluation of hand grip strength is of crucialimportance in the assessment of upper limb impairment[2], indeterminingtheeffectiveness of various treatmentmodalities [22], and in evaluating work capacity of patientswitheitherlocal handinjuriesorsystemicclinical entitiesthat influence hand strength such as rheumatoid arthritis ormuscular dystrophy. In particular, the establishment ofnormsinhandstrengthisbothnecessaryandimportantindecision making in hand surgery to interpret evaluationdata, to set realistic treatment goals, and to assess a patientsabilityto return to employment [12].Several studies have reported normative data of hand GSfromdifferentpopulationsusingavarietyofmeasurementmethods [3, 5, 6, 8]. The Jamar dynamometer has beenInternational Orthopaedics (SICOT) (2009) 33:713717DOI 10.1007/s00264-008-0551-xG. Mitsionis:E. E. Pakos: K. S. Stafilas: N. Paschos:T. Papakostas: A. E. BerisDepartment of Orthopaedic Surgery,University Hospitalof Ioannina, University of Ioannina,School of Medicine,Ioannina, GreeceE. E. Pakos (*)Neohoropoulo, POB: 243,Ioannina 45500, Greecee-mail: epakos@yahoo.grfound to give the most accurate and acceptable measures ofGS[12, 14]. Theaimof thisstudywastoestablishdataconcerningnormal handGSinthe populationof north-western Greece. We studied normal hand strength, thedifferencebetweendominantandnondominanthands,andtheassociationofparameterssuchasage, height, weight,and body massindex (BMI) with GS.Materials and methodsThis study included 232 individuals. The sample wasrandomly selected fromthe emergency roomof theIoanninaUniversityHospital. All patientsincludedinthestudy referred to the emergency roomfor traumaticconditions of the lower extremities. Exclusion criteriaincludedthe restrictionof movement inthe upper limbsand self-reported history of inflammatory joint disease,neurologicaldisorder,orinjurytotheupperextremity.Allsubjects were from the Epirus region, which includes urban,suburban, and rural areas. Therefore, it was assumed that abroad range of socio-economic and occupational groupswas obtained. Participants were identified in the study usinga coding scheme to maintain anonymity.Anthropometric measures were collected fromeachindividual, and the correlation between these measuresand hand GS were examined. The anthropometric measuresthat were obtained fromeach participant were weight,height, andhanddominance. Valueswererecordedtothenearest millimetre as part of the subject data. Otherparameters such as age, sex, and occupation were alsorecorded.All measurements were performed for both dominantand nondominant hands. Dominant hand was defined as theone preferred for daily activities like writing and eating andfor handling heavy objects.The standard, adjustable-handle mechanic Jamar dyna-mometer (FEI, Irvington, NY, USA) was used. For stan-dardisationit wasset at thesecondhandlepositionforallsubjects. Thestandardarmpositionforhandstrengthtestssuggested by the American Society of Hand Therapists wasused withtheparticipantseatedwiththeshoulderadductedandneutrallyrotated,elbowflexedat90,andtheforearmand wrist in neutral position.Subjects performedthree maximumattempts for eachmeasurement and the highest value of these trials wasrecorded. It has beenreportedthat if repeatedtestingisperformedthebest result andnot theaverage shouldberecorded[5]. One-minuterests weregivenbetweeneachattempt. Standard instructions were used: the subjects wereaskedtosqueezethegaugeashardastheypossiblycouldwith the extremity in the standard position. No verbalencouragement was provided. Results were recorded to theclosest pound. Calibration of the instrument was testedperiodically during the study.A t test forindependent sampleswasusedtodeterminewhether or not there was a significant difference in the meanvalues. We calculated the Pearson correlation coefficient forparameters that followed a normal distribution and thenonparametricSpearmans correlationcoefficient for thosewith a non-normal distribution. We examined the associationofage, height, weight, andBMIwithGSofthedominanthand. In order to test for the association of these variables tothedominanthandGSweperformedlinearregression. Allanalyses were performed in the whole group of patients andstratified by sex. P values