TO THE EDITOR:
The article "Side-to-Side Confrontational Strength-Testing for Weakness of the Intrinsic Muscles of the Hand" (79-A: 401—405, March 1997), by Buschbacher, was interesting. However, there appear to be a few drawbacks to this method that the author did not mention. Confrontational testing is a method of detecting a relative weakness of the muscles of one hand compared with those of the contralateral hand. This means that the test cannot be used in patients who have symmetrical weakness. Even when a patient has asymmetrical weakness, the test can at best serve only as a complement to standard manual testing, which is essential for detecting the weakness in the first place. Therefore, it appears that confrontational testing, although invaluable for the detection of subtle unilateral weaknesses, must be preceded by standard manual testing of hand intrinsics in the examination protocol of the attending surgeon.
T. M. Sunil, M.S.Orth., D.N.B.Orth.: Department of Orthopaedic Surgery, M. S. Ramaiah Medical College, Bangalore 560 054, India
Dr. Buschbacher replies:
Dr. Sunil raises a good point, which was mentioned in my article, that confrontational strength-testing is a non-specific method of detecting relative weakness of the muscles of one hand compared with those of the contralateral hand. Such asymmetrical weakness is not necessarily due to neurological causes but can be due to any kind of disuse or post-traumatic weakness. The only point that I wish to make is that, in my experience and as described in my article, standard strength-testing is very insensitive for detecting weakness except in patients who have substantial muscle atrophy, and in those cases it is already apparent that one hand will be weaker than the other. Again, Dr. Sunil brings up a good point in noting that confrontational strength-testing is non-specific, as is any kind of strength-testing.
Ralph Buschbacher, M.D.: Indiana University Medical Center, Clinical Building 368, 541 North Clinical Drive, Indianapolis, Indiana 46202-5111