Correlation of hand functionality and grip strengths with anthropometric measurements

Abstract

BACKGROUND:

Using objective anthropometric measurement data and anthropometric ratios, grip strength and hand functionality can be evaluated.

OBJECTIVE:

The aim of this study was to obtain anthropometric measurements regarding the forearm and hand, to evaluate the hand functionality in addition to hand and finger grip strengths, and to investigate the correlation between these values.

METHODS:

One-hundred eight-four subjects between 18 and 25 years were included in the study. Forearm and hand anthropometric measurements and ratios were measured. Hand and lateral grip strengths were evaluated. Jebsen Taylor Hand Function Test (JTHFT) was used to assess hand functionality.

RESULTS:

A statistically weak and consistently negative correlation between the ratios of forearm length to forearm/wrist circumferences and the ratio of hand length to metacarpal head circumference and hand-lateral grip strengths was found. There was a statistically weak and consistently negative correlation between these ratios and the subtests of JTHFT. It was shown that there was a statistically weak–moderate positive correlation between the hand-lateral grip strengths and JTHFT subtests.

CONCLUSIONS:

In conclusion, when evaluating grip strength and hand functionality, forearm and hand anthropometric measurements and ratios, which could affect the results, should be considered.

Keywords

Anthropometry function strength upper extremity physical examination

1 Introduction

The hand is one of the most frequently used organs for daily living activities in addition to occupational- and work-related activities. The coordinated combination of motor, sensory, and biomechanical parameters of the hand participate in functional activities, and significant and effective movements are used in daily life activities [1, 2]. Negative functional status and losses of strength in upper extremities are a decisive factor for lower quality of life and higher healthcare costs in addition to an increase in disability level [3, 4].

It is known that hand and finger grip strengths play an important role in providing hand and upper extremity functionality [5]. Functionality is provided in daily activities and work-related activities with different types of grip that may originate in the hands and fingers [6]. All types of grip, except for a strong grip, require functioning of and strength in intrinsic hand muscles. Especially for the lateral, end-to-end, and triple grips, the functionality of the hand is rather important [5 –7]. The evaluation of hand and finger grip strengths is, therefore, accepted and used as an objective measure in the measurement of upper extremity functionality [8]. This method, frequently used by clinicians to monitor the clinical status of patients with upper extremity problems; also provides data for physiotherapists and occupational therapists to help determine treatment goals, to assess the effectiveness of treatment, and to measure the level of competence required for the activity [9].

In addition to showing that hand and grip strengths in addition to hand functionality are correlated with the muscle strength in the upper extremities [6 , 10], studies in the literature reveal overall body muscle strength, forearm volume, forearm length, forearm circumference measurement, and anthropometric factors, such as hand sizes, are correlated with age, the body mass index (BMI), and the height [11 –14]. Moreover, the evaluation of finger grip strengths, is often used to analyse hand functions. Finger grip strength was found to be related to anthropometric measurements such as the forearm length and the finger lengths [15 –18].

Based on objective anthropometric data and anthropometric ratios, it is possible to evaluate grip strengths and hand functionality [19]. Clinicians can also objectively monitor the recovery status using these data and ratios [9, 19]. Studies in the literature can be found in which hand functionality and hand and finger grip strengths with anthropometric measurements were shown to be correlated [5–7 , 15]. In light of our current knowledge, no studies evaluating both grip strength and hand functionality together in addition to analyzing their relationship with anthropometric measurements have been done. Based on the idea that hand function and hand and finger grip strengths, which play an important role in daily life activities, can be affected by anthropometric measurement values, the aim of our study was to obtain anthropometric measurements regarding the forearm and hand, to evaluate the hand functionality in addition to hand and finger grip strengths, and to investigate the relationship between these values.

2 Methods

Before conducting the study, approval was granted by the Clinical Research Ethics Committee of the Faculty of Medicine of Akdeniz University (70904504/158, Decision No: 280). The individuals included in the study were informed about the study, and the necessary permits were granted after they signed informed consent forms. Our study was performed on 191 young subjects (ages between 18 and 25 years) with their dominant extremities being right-sided.

Inclusion criteria included several parameters: (1) between the ages of 18 and 25, (2) having the same dominant extremity (Right), (3) to be able to communicate verbally, (4) not having any diseases diagnosed by a doctor or the functional level being affected by some disability, (5) volunteering to participate in the study, and (6) having read and approved the informed consent form. Exclusion criteria consisted of several parameters: (1) refusing to participate in the study, (2) having undergone any surgical operation on the upper extremity in the last six months, (3) diagnosis of chronic disease related to neurological, rheumatological, psychiatric, and cancer-related problems, (4) communication problems due to advanced mental and cognitive problems, (5) skin injury of an upper extremity, (6) an open wound of an upper extremity with a risk of infection, and (7) orthopedic problems in upper extremities.

Three subjects were excluded from the study since they had a job requiring an advanced level of dexterity; two were excluded because their evaluation parameters did not allow them to complete the study, and two others were excluded since they did not allow for the use of their results. As a result, 184 subjects were included in this study.

For all of the subjects included in the study, the measurements for the forearm and hand length, the forearm, wrist, and the metacarpal head circumference measurements were conducted using a foldable, nonelastic measuring tape of 7 mm at points indicated in Figs. 1 2 [20].

Fig. 1

Anthropometric Measurements-I.

Fig. 2

Anthropometric Measurements-II.

For the measurement of hand grip strength, the Baseline^® Hydraulic Hand Dynamometer was used. The evaluation was conducted using the standard measuring method of the American Society of Hand Therapists (ASHT). For the evaluation, the participant was held in an upright sitting position with feet in contact with the ground, arm next to the body, elbow at 90° flexion, and the forearm and wrist in neutral positions. To evaluate hand grip strength, the hand of the participant that was subject to evaluation was placed in a way such that it would grasp the second measuring range of the dynamometer. Grip strengths were evaluated by changing hands between the measurements, and three measurements were conducted per hand. An interval of 15 sec between each measurement was used. The average of three measurements (in lb) was recorded as the grip strength of the dominant and nondominant extremities [21]. The Baseline^® Pinchmeter was used for the measurement of lateral grip strength. The measurement was conducted by placing the device between the lateral end of the second finger and the tip of the thumb in a way such that it would be in the same position as the hand grip strength. Each measurement was performed three times, and the average of these three measurements was recorded for the dominant and nondominant extremities [22].

The Jebsen Taylor Hand Function Test (JTHFT) was used to evaluate hand functionality of participants. The JTHFT consists of seven subtests, consisting of writing, card turning, picking up small objects, simulated feedings, stacking checkers, moving light objects, and moving heavy objects, was performed first in the nondominant extremity. Norms were categorized by the longest duration, hand dominance, and gender. The JTHFT subtests were performed on a test board with a length of 105.5 cm, thickness of 2 cm, and width of 28 cm [23].

2.1 Statistical analysis

In the statistical analysis of data obtained in our study, the Windows-based SPSS (IBM SPSS Statistics, version 23.0; IBM Corp., Armonk, NY, USA) package was used. The sample size was calculated based on an observed effect size of d = 0.66 reported for the correlation between hand grip strength and forearm circumference [7]. To achieve 80%power to detect a difference with 95%confidence using the Pearson correlation test, a sample of 164 participants was required for this study [7]. Analytical (Kolmogorov–Smirnov/Shapiro–Wilks test) and visual (histogram and probability graphs) methods were used to test the suitability of data for normal distribution. Descriptive statistical information was given in average±standard deviation ( $\bar{x} \pm SD$ ) and percentages. An independent Student’s t-Test was used to measure the statistical significance of the difference between male and female participants. Pearson’s correlation analysis was used to analyze the relationship between anthropometric measurement, grip strength, and hand functionality. In the evaluation of the relationship, correlation coefficients were classified based on four groups: (1) 0–0.24: weak, (2) 0.25–0.49: moderate, (3) 0.50–0.74: strong, and (4) 0.75–1.00: very strong [24]. p < 0.05 was considered statistically significant in our study.

3 Results

The percentage of 48.9 participants was female at mean age of 20.85±2.56 years, and 51.1%were male with average age of 21.20±2.08 years. More than half of the participants (59.2 %) are or had been students at the university. Table 1 shows the demographic characteristic of participants.

Table 1
Demographic Characteristics of the Participants

Variables (n = 184) Mean±SD

Age (years) 21.03±2.33

Height (cm) 172.04±8.54

Weight (kg) 69.21±14.79

BMI (kg/m²) 23.18±3.63

Gender n (%)

Male 94 (51.1)

Female 90 (48.9)

Marriage Status

Married 25 (13.6)

Single 159 (86.4)

Participants’ Education

Illiterate 0

Less than high school 20 (10.9)

High School 113 (61.4)

University 45 (24.5)

Graduate degree 6 (3.3)

Working Status

Unemployed 12 (6.5)

Student 109 (59.2)

Physiotherapist 25 (13.6)

Self-employed 22 (12)

Teacher 7 (3.8)

Research assistant 9 (4.9)

Dominant Nondominant

Anthropometric Measurements (cm)

Forearm Length 28.24±2.40 28.24±2.40

Hand Length 18.27±1.44 18.27±1.44

Forearm Circumference 22.35±3.31 22.35±3.31

Wrist Circumference 16.31±1.82 16.31±1.82

Metacarpal Head Circumference 19.51±1.91 19.51±1.91

The Ratio of Forearm Length to Forearm Circumference 1.27±0.10 1.27±0.10

The Ratio of Forearm Length to Wrist Circumference 1.74±0.14 1.74±0.14

The Ratio of Hand Length to Metacarpal Head Circumference 0.93±0.05 0.93±0.05

Grip Strengths (lb)

Hand Grip Strength 33.84±8.94 30.79±9.15

Lateral Grip Strength 8.81±2.37 7.88±2.22

JTHFT (sec)

Writing 9.85±1.35 26.39±5.91

Card Turning 5.61±0.66 6.77±0.64

Picking Up Small Objects 7.07±1.10 7.75±1.14

Simulated Feedings 8.15±1.00 9.95±1.12

Stacking Checkers 4.00±0.91 4.66±0.92

Moving Light Objects 4.52±0.67 5.26±0.75

Moving Heavy Objects 4.75±0.75 5.35±0.78

Variables (n = 184)	Mean±SD
Age (years)	21.03±2.33
Height (cm)	172.04±8.54
Weight (kg)	69.21±14.79
BMI (kg/m²)	23.18±3.63
Gender	n (%)
Male	94 (51.1)
Female	90 (48.9)
Marriage Status
Married	25 (13.6)
Single	159 (86.4)
Participants’ Education
Illiterate	0
Less than high school	20 (10.9)
High School	113 (61.4)
University	45 (24.5)
Graduate degree	6 (3.3)
Working Status
Unemployed	12 (6.5)
Student	109 (59.2)
Physiotherapist	25 (13.6)
Self-employed	22 (12)
Teacher	7 (3.8)
Research assistant	9 (4.9)
	Dominant	Nondominant
Anthropometric Measurements (cm)
Forearm Length	28.24±2.40	28.24±2.40
Hand Length	18.27±1.44	18.27±1.44
Forearm Circumference	22.35±3.31	22.35±3.31
Wrist Circumference	16.31±1.82	16.31±1.82
Metacarpal Head Circumference	19.51±1.91	19.51±1.91
The Ratio of Forearm Length to Forearm Circumference	1.27±0.10	1.27±0.10
The Ratio of Forearm Length to Wrist Circumference	1.74±0.14	1.74±0.14
The Ratio of Hand Length to Metacarpal Head Circumference	0.93±0.05	0.93±0.05
Grip Strengths (lb)
Hand Grip Strength	33.84±8.94	30.79±9.15
Lateral Grip Strength	8.81±2.37	7.88±2.22
JTHFT (sec)
Writing	9.85±1.35	26.39±5.91
Card Turning	5.61±0.66	6.77±0.64
Picking Up Small Objects	7.07±1.10	7.75±1.14
Simulated Feedings	8.15±1.00	9.95±1.12
Stacking Checkers	4.00±0.91	4.66±0.92
Moving Light Objects	4.52±0.67	5.26±0.75
Moving Heavy Objects	4.75±0.75	5.35±0.78

SD: Standard Deviation, cm: Centimeter, kg: Kilogram, m: Meter, n: Sample Size, lb: Pound, sec: Second.

Anthropometric measurements, grip strengths, and JTHFT are shown in Table 2. In the male group, forearm circumferences and hand and lateral grip strengths were greater than females with respect to both extremities. Also, the ratio of forearm length to wrist circumference was lower than in females. In the four subtests of the JTHFT (writing, picking up small objects, stacking checkers, and moving heavy objects), males were slower than woman when using their dominant extremity.

Table 2

Anthropometric Measurements, Anthropometric Measurement Ratios, Grip Strengths, and Hand Functionality Results

Variables	Female (n = 90) Mean±SD		Male (n = 94) Mean±SD		Mean Difference		95 CI % (Lower-Upper)		p
	Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom
Anthropometric Measurements (cm)
Forearm Length	26.55±1.72	26.55±1.72	29.85±1.76	29.85±1.76	–3.3	–3.3	–3.8––2.79	–3.8––2.79	< 0.0001^a	< 0.0001^a
Hand Length	17.25±0.98	17.25±0.98	19.25±1.09	19.25±1.09	–1.99	–1.99	–2.3––1.69	–2.3––1.69	< 0.0001^a	< 0.0001^a
Forearm Circumference	19.38±1.07	19.38±1.07	25.19±1.97	25.19±1.97	–5.8	–5.8	–6.27––5.34	–6.27––5.34	<0.0001^a	<0.0001^a
Wrist Circumference	15.08±1.41	15.08±1.41	17.48±1.33	17.48±1.33	–2.39	–2.39	–2.79––1.99	–2.79––1.99	< 0.0001^a	< 0.0001^a
Metacarpal Head Circumference	18.15±1.32	18.15±1.32	20.80±1.42	20.80±1.42	–2.65	–2.65	–3.05––2.25	–3.05––2.25	< 0.0001^a	< 0.0001^a
The Ratio of Forearm Length to Forearm Circumference	1.37±0.05	1.37±0.05	1.18±0.05	1.18±0.05	0.18	0.18	0.16–0.19	0.16–0.19	< 0.0001^a	< 0.0001^a
The Ratio of Forearm Length to Wrist Circumference	1.77±0.16	1.77±0.16	1.71±0.11	1.71±0.11	0.05	0.05	0.01–0.09	0.01–0.09	0.006^a	0.006^a
The Ratio of Hand Length to Metacarpal Head Circumference	0.95±0.06	0.95±0.06	0.92±0.05	0.92±0.05	0.02	0.02	0.008–0.04	0.008–0.04	0.003^a	0.003^a
Grip Strengths (lb)
Hand Grip Strength	45.13±10.44	37.92±9.42	71.91±13.27	65.46±14.44	–26.77	–27.53	–30.26––23.29	–31.1––23.97	< 0.0001^a	< 0.0001^a
Lateral Grip Strength	11.83±3.06	9.65±2.28	16.93±3.43	14.98±3.48	–5.09	–5.32	–6.04––4.14	–6.18––4.46	< 0.0001^a	< 0.0001^a
JTHFT (sec)
Writing	9.62±1.05	23.51±4.20	10.07±1.55	29.14±6.02	–0.45	–5.63	–0.84––0.06	–7.15––4.11	0.022^a	< 0.0001^a
Card Turning	5.71±0.66	6.82±0.77	5.51±0.64	6.73±0.50	0.19	0.09	0.003–0.38	–0.09–0.27	0.046^a	0.345
Picking Up Small Objects	6.87±0.44	7.75±0.84	7.25±1.46	7.75±1.36	–0.37	–0.001	–0.69––0.06	–0.33–0.33	0.02^a	0.992
Simulated Feedings	8.10±1.04	9.67±1.10	8.19±0.96	10.23±1.07	–0.09	–0.55	–0.38–0.2	–0.87––0.23	0.544	0.001^a
Stacking Checkers	3.85±0.39	4.51±0.61	4.14±1.20	4.81±1.13	–0.28	–0.29	–0.55––0.02	–0.56––0.03	0.031^a	0.029^a
Moving Light Objects	4.53±0.56	5.27±0.68	4.52±0.76	5.24±0.80	0.007	0.02	–0.18–0.2	–0.19–0.24	0.937	0.798
Moving Heavy Objects	4.74±0.53	5.47±0.72	4.76±0.91	5.24±0.81	–0.01	0.23	–0.23–0.2	0.11–0.46	0.878	0.039^a

p < 0.05, p^a: Independent Student t Test, SD: Standard Deviation, cm: Centimeter, kg: Kilogram, lb: libre, sec: Second, n: Sample Size, Dom: Dominant, NonDom: Nondominant, JTHFT: Jebsen Taylor Hand Function Test.

The correlation between the ratios of anthropometric measurements and hand and lateral grip strengths are shown in Table 3. Statistically, there was a strong negative correlation between the ratio of forearm length to forearm circumference and hand and lateral grip strengths in the dominant and non-dominant extremities. A significant but weak negative correlation was shown in the ratio of forearm length to wrist circumference and hand and lateral grip strengths in both extremities. Also, a significant but moderate negative correlation was found in the ratio of the hand length to the metacarpal head circumference and hand and lateral grip strengths in both extremities (p < 0.05).

Table 3

The Relationship Between Hand Grip and Lateral Grip Strengths with Anthropometric Measurement Ratios

Variables	Hand Grip Strength				Lateral Grip Strength
	Dominant		Nondominant		Dominant		Nondominant
	r	p	r	p	r	p	r	p
The Ratio of Forearm Length to Forearm Circumference	–0.604^*	0.000^b	–0.627^*	0.000^b	–0.534^*	0.000^b	–0.593^*	0.000^b
The Ratio of Forearm Length to Wrist Circumference	–0.240^*	0.001^b	–0.226^*	0.002^b	–0.164^*	0.026^a	–0.157^*	0.033^a
The Ratio of Hand Length to Metacarpal Head Circumference	–0.337^*	0.000^b	–0.326^*	0.000^b	–0.284^*	0.000^b	–0.250^*	0.001^b

^ap < 0.05; ^bp < 0.01.

The correlations between the ratios of anthropometric measurements and subtests of JTHFT are described in Table 4. Statistically, a weak negative correlation between the ratio of forearm length to the forearm circumference and writing, picking up small objects, simulated feedings, and stacking checker subtests of JTHFT in the dominant extremity was found. Also, strong–moderate and weak correlations between the ratio of forearm length and forearm circumference were found between this ratio and writing and between this ratio and simulated feeding and moving heavy objects in the non-dominant extremities, respectively. Strong–moderate and weak correlations between the ratio of forearm length and wrist circumference measurements were found between this ratio and picking up small objects and between this ratio and moving light and heavy objects in the non-dominant extremities, respectively.

Table 4

The Relationship Between Anthropometric Measurement Ratios and Hand Functionality

Variables	JTHFT
	Writing		Card Turning		Picking Up Small Objects		Simulated Feedings		Stacking Checkers		Moving Light Objects		Moving Heavy Objects
	Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom
	r	r	r	r	r	r	r	r	r	r	r	r	r	r
	p	p	p	p	p	p	p	p	p	p	p	p	p	p
The Ratio of Forearm Length to Forearm Circumference	–0.178^*	–0.522^*	–0.024	–0.010	–0.180^*	–0.062	–0.192^*	–0.378^*	–0.175^*	–0.140	–0.080	–0.022	–0.096	–0.159^*
	0.016^a	0.000^b	0.744	0.891	0.014^a	0.401	0.009^b	0.000^b	0.018^a	0.058	0.279	0.764	0.194	0.032^a
The Ratio of Forearm Length to Wrist Circumference	–0.113	–0.141	–0.011	–0.006	–0.100	–0.298^*	–0.105	–0.119	–0.088	–0.031	–0.005	–0.243^*	–0.063	–0.205^*
	0.127	0.056	0.877	0.931	0.177	0.000^b	0.154	0.107	0.233	0.677	0.945	0.001^b	0.403	0.005^b
The Ratio of Hand Length to Metacarpal Head Circumference	–0.095	–0.019	–0.008	–0.182^*	–0.341^*	–0.325^*	–0.152^*	–0.210^*	–0.234^*	–0.300^*	–0.052	–0.162^*	–0.044	–0.146^*
	0.197	0.799	0.912	0.013^a	0.000^b	0.000^b	0.039^a	0.004^b	0.001^b	0.000^b	0.487	0.028^a	0.554	0.048^a

^ap < 0.05; ^bp < 0.01, JTHFT: Jebsen Taylor Hand Function Test, Dom: Dominant, NonDom: Nondominant.

For the dominant extremity, a significant but moderate correlation between the ratio of hand length and metacarpal head circumference and picking up small objects was found. A weak correlation between this same ratio and simulated feedings and stacking checkers was also found. For the non-dominant extremity, a moderate correlation between this ratio and card turning, simulated feedings, moving light and heavy objects, picking up small objects, and stacking checkers was noted (Table 4).

Table 5 presents the correlations between both hand and lateral grip strengths and subtests of JTHFT. Significant but weak and moderate correlations between hand and lateral grip strengths and writing, card turning, picking up small objects, simulated feedings, stacking checkers, and moving heavy objects with respect to both extremities were found.

Table 5

The Relationship Between Hand Grip and Lateral Grip Strengths and Hand Functionality

Variables	JTHFT
		Writing		Card Turning		Picking Up Small Objects		Simulated Feedings		Stacking Checkers		Moving Light Objects		Moving Heavy Objects
		Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom	Dom	NonDom
		r	r	r	r	r	r	r	r	r	r	r	r	r	r
		p	p	p	p	p	p	p	p	p	p	p	p	p	p
Hand Grip Strength	Dom	0.022	0.340^*	0.216^*	0.202^*	0.019	0.190^*	0.116	0.379^*	0.142	0.174^*	0.049	0.027	0.023	0.164^*
		0.769	0.000^b	0.003^b	0.006^b	0.794	0.010^b	0.118	0.000^b	0.055	0.018^a	0.510	0.715	0.757	0.026^a
	NonDom	0.007	0.383^*	0.132	0.140	0.081	0.181^*	0.175^*	0.444^*	0.223^*	0.237^*	0.144	0.110	0.070	0.080
		0.926	0.000^b	0.073	0.059	0.273	0.014^a	0.018^a	0.000^b	0.002^b	0.001^b	0.051	0.138	0.346	0.278
Lateral Grip Strength	Dom	0.006	0.284^*	0.344^*	0.291^*	0.027	0.146^*	0.191^*	0.189^*	0.147^*	0.055	0.117	0.097	0.210^*	0.217^*
		0.934	0.000^b	0.000^b	0.000^b	0.719	0.049^a	0.010^b	0.010^a	0.046^a	0.456	0.112	0.191	0.004^b	0.003^b
	NonDom	0.007	0.371^*	0.339^*	0.237^*	0.020	0.154^*	0.147^*	0.203^*	0.149^*	0.081	0.111	0.128	0.205^*	0.256^*
		0.921	0.000^b	0.000^b	0.001^b	0.793	0.037^a	0.046^a	0.006^b	0.044^a	0.274	0.134	0.083	0.005^b	0.000^b

^ap < 0.05; ^bp < 0.01, JTHFT: Jebsen Taylor Hand Function Test, Dom: Dominant, NonDom: Nondominant.

4 Discussion

To the best of our knowledge, no study has investigated the correlation between anthropometric measurements of hands and forearms in addition to hand grip and lateral grip strengths and hand function. The findings of this present study demonstrate that significant but weak to strong correlations between the ratios of anthropometric measurements and hand function and both hand and lateral grip strengths were found.

Hand and finger grip strengths are affected many factors, such as anthropometric measurement values (forearm length, forearm circumference measurement), hand dominance, gender, height, body mass index, age, and nutritional status [9–11 , 25]. Generation and release of strength depend on the laws of physics. Muscle strength is significantly influenced by the muscle mass during movement and for physiological cross-sectional areas, and arrangements of muscular lever systems [6]. Coordinated functioning of wrist and finger extensors with long flexor muscles is required for the release of hand-finger grip strengths [2]. To release isometric force during the grip, the wrist extensor muscles are required to be involved in the movement process [3]. In the superficial electromyographic (EMG) studies, it was observed that high activity of long flexor muscles in fingers was required for the grip movement while the wrist extensors stabilized carpal, midcarpal, and metacarpophalangeal joints [26]. In a study by Anakwe et al., it was shown that grip strength increased as the measurement value of forearm circumference increased [19]. Chong et al. concluded that there was a strong positive correlation between the forearm circumference measurement and finger grip strength [27]. In a study analyzing the correlation between hand grip and finger strength and anthropometric measurements, it was concluded that grip strengths increased as arm and forearm measurements increased [28]. Mohammadian et al. included 1008 participants aged between 20 and 107 and investigated the relationship between anthropometric measurement and hand-finger grip strengths. Their findings demonstrated that grip strengths gradually increased when forearm circumference was increased [29]. Narin et al. reported that hand and finger grip strengths increased due to the decrease in the ratio of the forearm length to the forearm circumference measurement as caused by the increase in the forearm circumference used in this present study [9]. In another recent study, Eidson et al. [30] investigated the relationship between maximal hand grip strength and anthropometric measurements. They reported that hand width was one of the best assessment areas for predicting maximal hand strength. The findings of the present study support findings from the literature. The differences in our findings from those in the literature indicate that hand grip and lateral grip strengths may increase due to the decrease in the ratio of the hand length measurement to the metacarpal head circumference measurement in addition to the ratio of the forearm length to the wrist circumference measurement. In this present study, it was confirmed that there were negative strong correlations between the ratio of the forearm length to forearm circumference measurement and hand and lateral grip strengths. These negative correlations showed that the cross sectional areas of muscle are gradually increased when the ratio of the forearm length to forearm circumference are decreased. In this way, hand and lateral grip strength are increased. Our findings support those in from the literature with respect to the relationships between forearm anthropometric measurements and grip strengths.

A hand held dynamometer might provide information about hand functionality [5, 10]. Measurement of hand and finger grip strengths based on guidelines by the American Society of Hand Therapists (ASHT) is considered gold standard in addition to being proven valid and reliable [21 , 32]. Moreover, the validity and reliability study of the JTHFT, which is used for the evaluation of hand functionality, is a frequently used method for the evaluation of hand functionality [33]. Although hand–finger dynamometers and JTHFT are easy to use and affordable tools, they may not be available in clinical settings. The ratios of anthropometric measurements providing in our study and the predictive evaluation of hand-lateral grip strengths and hand functionality might be an affordable and fast method for obtaining these types of measurements. In our study, there was strong correlation between the ratio of forearm length to forearm circumference and writing in nondominant extremity. In addition, there were moderate correlations between the ratios of anthropometric measurements and hand functions were noted including picking up small objects, simulated feelings, stacking checkers. At first step of evaluation of the patient, these findings might provide an insight into hand functions by using anthropometric measurements. It is practical, time efficient, cheap, easily accessible, and useful measurement methods for clinicians. However, these are not give exhaustive information about hand functions.

The increase in hand and finger grip strengths appears to be crucial for undertaking activities in daily life [6 , 20]. In a study conducted with 101 female volleyball players between 18 and 25 years, it was concluded that the handgrip strength increased as forearm circumference measurements and hand length increased [34]. In that study, it was shown that it is possible to provide information about grip strengths and to design training programs using objective anthropometric measurement methods [34]. Günther et al. [18], observed 769 participants in their study in whom there was a strong correlation between lateral grip strength and the forearm length in addition to forearm circumference measurements and the hand size. In the same study, it was emphasized that the lateral grip strength can be used to determine the functional status of the hand [18]. In a study conducted with 100 male and 64 female participants, the relationship between the grip strength and the hand length and general posture was analysed. They indicated that the maximum isometric grip strength was affected by posture and hand length [11]. In our study, similar to those in the literature, it was observed that grip strengths and hand functionality increased based on anthropometric measurement values.

As a result of our study and in agreement with the literature, it was confirmed that there were relationships between the ratio of anthropometric measurements, hand function and hand-lateral grip strengths. Moreover, the ratios of the forearm length to the wrist circumference and of hand length to the metacarpal head circumference were first presented in the current study. The decrease in these ratios could require the forearm, wrist, and metacarpal head circumferences to be greater, whereas the forearm length and the hand length should be smaller. This finding might be explained by the fact that the physiological cross-sectional area of the muscle, having a direct relationship with muscle strength, is greater.

4.1 Strengths and limitations

Limitations of our study included no investigation of factors, such as body mass index, occupation, nutritional status, and exercising, all of which would affect grip strength and functionality. Strong points of the study were shown by the same dominant extremity (right) in all participants and data collection was conducted in a safe and standardized manner since all the measurements were performed by the same researcher. Moreover, another strong point of our study was that the correlation of the ratio of the forearm length to the wrist circumference measurement and ratio of the hand length to the metacarpal head in addition to the correlation between grip strengths and hand functionality are presented for the first time.

5 Conclusion

This present study investigating the relationship between hand functionality, strength, and the ratio of hand/forearm lengths to their circumferences proved weak to strong statistically significant relationships existed among them. Our findings demonstrated strong correlations between the ratio of forearm length to forearm circumference and hand/lateral grip strengths for dominant and nondominant extremities. In addition, the ratio of forearm length to forearm circumference had a statistically significant strong correlation with writing function in the nondominant extremity. Therefore, these findings might be crucial, practical, and useful for clinicians when evaluating patients.

In light of the current findings in our study, the ratio of anthropometric measurements for forearm and hand might have a weak to strong correlation between both hand and lateral grip strengths and hand functionality. Grip strengths and hand functionality, forearm and hand lengths, and forearm, wrist circumference, and metacarpal head circumference measurements, could impact the findings and should be taken into consideration in clinical settings.

Conflict of interest

There is no conflict of interest.

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