title: Tripod pinch strength and thumb opposition are the major determinants of manual dexterity in Charcot-Marie-Tooth disease type 1A.
abstract: BACKGROUND
  Clinical features of Charcot-Marie-Tooth disease type 1A (CMT1A) include slowly progressive distal muscle weakness, atrophy and sensory loss. Upper-limb involvement results in reduced manual dexterity interfering with the execution of daily activities.
  
  
  OBJECTIVE
  To identify which hand function impairments are determinants of manual dexterity in CMT1A.
  
  
  METHODS
  In a cross-sectional, observational study, hand function (strength, mobility and sensory function) and manual dexterity (Sollerman hand function test) were evaluated in adults with CMT1A. Multiple linear regression analysis was used to determine the independent contribution of hand function variables on manual dexterity. Multifocal motor neuropathy (MMN) patients were chosen as a reference group with only motor impairments.
  
  
  RESULTS
  Forty-nine proven CMT1A patients (21 males, mean age 47+/-12) and 15 MMN patients (12 males, mean age 54+/-8) were studied. Hand strength, mobility and sensory functions were impaired in CMT1A compared with normal values. Limited manual dexterity was found in 94% of the CMT1A patients. From the investigated determinants (age, gender, grip and pinch strength, joint mobility, thumb opposition, touch, discrimination and vibration sense), tripod pinch strength, thumb opposition and, to a lesser degree, vibration sense were independently associated with manual dexterity (69% explained variance). Tripod pinch strength was also most strongly associated with manual dexterity in MMN.
  
  
  CONCLUSIONS
  Tripod pinch strength and thumb opposition are major determinants of manual dexterity in CMT1A and should therefore be the focus of intervention strategies that aim to preserve or enhance manual dexterity in CMT1A.
authors.affiliation: Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. a.j.videler@amc.uva.nl
authors.forename: Annemieke J
authors.initials: AJ
authors.lastname: Videler
authors.forename: Anita
authors.initials: A
authors.lastname: Beelen
authors.forename: Ivo N
authors.initials: IN
authors.lastname: van Schaik
authors.forename: Camiel
authors.initials: C
authors.lastname: Verhamme
authors.forename: Leonard H
authors.initials: LH
authors.lastname: van den Berg
authors.forename: Marianne
authors.initials: M
authors.lastname: de Visser
authors.forename: Frans
authors.initials: F
authors.lastname: Nollet
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D002607:Charcot-Marie-Tooth Disease / Q000503:physiopathology*; D005260:Female; D005385:Fingers / Q000503:physiopathology*; D050823:Hand Joints / Q000503:physiopathology; D018737:Hand Strength / Q000502:physiology; D015417:Hereditary Sensory and Motor Neuropathy / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D018763:Muscle Fatigue / Q000502:physiology; D052581:Pinch Strength / Q000502:physiology*; D016059:Range of Motion, Articular; D012044:Regression Analysis; D012677:Sensation / Q000502:physiology; D012684:Sensory Thresholds / Q000502:physiology; D014110:Touch / Q000502:physiology; D055815:Young Adult