Evaluation of a grip-strengthening algorithm for the initial treatment of chronic, nonspecific wrist pain in adolescents

Key points

1. 01Roughly 75% of adolescents had their pain and functional limits resolve after the grip-strengthening protocol.
2. 02Affected-side grip strength rose from a mean of 32.2 to 47.9 lb, with parallel gains in patient-reported pain and function (all P<.001).
3. 03Bigger gains in grip strength tracked with bigger improvements in pain (r=0.64) and function (r=0.70).
4. 04The remaining 25% who did not improve were the ones identified as needing further evaluation or intervention such as surgery or injection.
5. 05No pretreatment characteristic predicted who would fail the protocol, so a trial of strengthening was reasonable even after prior failed conservative care.

How it was conducted

Design

Single-center retrospective chart review (Therapeutic Level IV)

Participants

32 adolescents (28 female, 4 male), mean age 14 years (range 10-18), 36 wrists treated

Intervention

Occupational-therapist-directed graded isometric grip-strengthening with therapeutic putty, home program building to 5 minutes twice daily, reassessed at 2, 4, and 6 weeks

Primary outcomes

Grip strength by handheld Jamar dynamometer; PODCI Pain/Comfort and Upper Extremity Function scores, pre- and posttreatment

Analysis

Paired t tests or Wilcoxon signed-rank tests, correlation coefficients, and linear/logistic regression; significance set at P<.05

What they found

• Affected-side grip strength improved from a mean of 32.2 lb (95% CI 29.5-38.8) to 47.9 lb (95% CI 42.9-52.9), P<.001.
• Unaffected-side grip strength improved from 43.4 lb (95% CI 36.7-50.0) to 50.4 lb (95% CI 44.0-56.9), P<.001.
• PODCI/pain scores improved from a mean of 49.0 (95% CI 42.8-55.2) to 78.2 (95% CI 70.8-85.7), P<.001.
• PODCI/UE function scores improved from a mean of 78.2 (95% CI 72.7-83.7) to 91.2 (95% CI 87.1-95.5), P<.001.
• Improvements in grip strength correlated with improvements in PODCI/pain (r=0.64) and PODCI/UE (r=0.70).
• Greater grip-strength gains were associated with lower pretreatment grip strength (P<=.001, B=-0.72); greater pain improvement with worse baseline pain and larger strength change (P=.003, B=-0.40 and P<.001, B=0.51).
• 8 of 32 patients (25%) met criteria for failure; 5 had successful further intervention, 2 received ongoing pain management, and 1 was lost to follow-up.
• Treatment lasted a mean of 40 days (range 21-82) with a median of 4 therapy visits (range 2-6).

Limitations

• Retrospective design with no comparison group, so improvement cannot be firmly separated from natural recovery over time.
• The link between strength gains and pain relief is a correlation and does not prove cause, since pain relief itself may allow stronger gripping.
• Follow-up ended when the protocol finished, so durability and recurrence of symptoms are unknown.
• Small single-center sample (32 patients) and reliance on a pain score that is not wrist-specific and can be affected by generalized pain syndromes.

Why it matters

For patients

Teenagers with unexplained wrist pain may get meaningful relief from a simple at-home grip-strengthening routine before considering imaging or surgery.

For clinicians

A structured grip-strengthening algorithm offers a low-burden first-line treatment for nonspecific adolescent wrist pain and helps systematically identify the minority who need further work-up.

For readers

This is early, single-group evidence that strengthening helps most teens with vague wrist pain, but a controlled trial is needed to confirm the effect.