Experimental Brain Research

, Volume 226, Issue 1, pp 137–143 | Cite as

Bilateral deficits in fine motor control ability and manual dexterity in women with fibromyalgia syndrome

  • Marta Pérez-de-Heredia-Torres
  • Rosa M. Martínez-Piédrola
  • Margarita Cigarán-Méndez
  • Ricardo Ortega-Santiago
  • César Fernández-de-las-Peñas
Research Article


The aim of the current study was to investigate fine motor control ability and manual dexterity women with fibromyalgia syndrome (FMS) without symptoms in the upper extremity compared to healthy women. Subtests of the Purdue Pegboard Test (one-hand, bilateral and assembly) and of the Jebsen–Taylor hand-function test (writing, turning cards, picking up small, light and large heavy objects, simulated feeding and stacking checkers) were evaluated bilaterally in 20 women with FMS (aged 35–55 years) without symptoms in the upper limb and 20 age- and hand dominance-matched healthy women. Differences between sides and groups were analysed with several analysis of variance (ANOVA). The ANOVA revealed significant differences between groups (P < 0.001) and sides (P = 0.007) for one-hand pin placement subtest: women with FMS showed bilateral worse scores than controls. Patients also exhibited significantly lower scores in bilateral pin placement and assembly subtests when compared to healthy controls (P < 0.001). The ANOVA also revealed significant differences between groups for writing, turning over cards, picking up small objects, stacking checkers, picking up large light objects and picking up large heavy objects (all, P < 0.001): women with FMS needed more time for these subtests than healthy women with both hands. No difference for simulated feeding was found between groups. Our findings revealed bilateral deficits in fine motor control ability and manual dexterity in patients with FMS without symptoms in the upper extremity. These deficits are not related to the clinical features of the symptoms supporting an underlying central mechanism of altered motor control.


Fibromyalgia syndrome Motor control Manual dexterity 


  1. Aparicio VA, Ortega FB, Heredia JM, Carbonell-Baeza A, Sjöström M, Delgado-Fernandez M (2011) Handgrip strength test as a complementary tool in the assessment of fibromyalgia severity in women. Arch Phys Med Rehabil 92:83–88PubMedCrossRefGoogle Scholar
  2. Backman C, Cork S, Gibson G, Parsons J (1992) Assessment of hand function: the relationship between pegboard dexterity and applied dexterity. Can J Occup Ther 59:208–213Google Scholar
  3. Bardal EM, Roeleveld K, Johansen TO, Mork PJ (2012) Upper limb position control in fibromyalgia. BMC Musculoskelet Disord 13:186PubMedCrossRefGoogle Scholar
  4. Beck AT, Steer RA, Brown GK (1996) Beck depression inventory, 2nd edn. The Psychological Corporation, San Antonio, TXGoogle Scholar
  5. Bijur P, Silveer W, Gallagher JE (2001) Reliability of the visual analogue scale for measurement of acute pain. Acad Emerg Med 8:1153–1157PubMedCrossRefGoogle Scholar
  6. Buddenberg LA, Davis C (2000) Test-retest reliability of the Purdue Pegboard Test. Am J Occup Ther 54:555–558PubMedCrossRefGoogle Scholar
  7. Burckhardt CS, Clark SR, Bennett RM (1991) The fibromyalgia impact questionnaire: development and validation. J Rheumatol 18:728–733PubMedGoogle Scholar
  8. Canny ML, Thompson JM, Wheeler MJ (2009) Reliability of the box and block test of manual dexterity for use with patients with fibromyalgia. Am J Occup Ther 63:506–510PubMedCrossRefGoogle Scholar
  9. Dombernowsky T, Dreyer L, Bartels EM, Danneskiold-Samsoe B (2008) Muscular strength in patients with fibromyalgia: a literature review. Ugeskr Laeger 170:217–224PubMedGoogle Scholar
  10. Elbert T, Candia V, Altenmüller E, Rau H, Sterr A, Rockstroh B, Pantey C, Taub E (1998) Alteration of digital representations in somatosensory cortex in focal hand dystonia. NeuroReport 9:3571–3575PubMedCrossRefGoogle Scholar
  11. Esteve-Vives J, Rivera-Redondo J, Salvat-Salvat I, Gracia-Blanco M, Alegre-Miguel C (2007) Propuesta de una versión de consenso del Fibromyalgia Impact Questionnaire (FIQ) para la población española. Reumatol Clin 3:21–24PubMedCrossRefGoogle Scholar
  12. Fernández-de-las-Peñas C, Pérez-de-Heredia M, Martínez-Piédrola R, De-la-Llave-Rincón AI, Cleland JA (2009) Bilateral deficits in fine motor control and pinch grip force in patients with unilateral carpal tunnel syndrome. Exp Brain Res 194:29–37PubMedCrossRefGoogle Scholar
  13. Flor H (2003) Cortical reorganization and chronic pain: implications for rehabilitation. J Rehabil Med 35(Suppl 41):66–72CrossRefGoogle Scholar
  14. Gallus J, Mathiowetz V (2003) Test-retest reliability of the Purdue Pegboard for persons with multiple sclerosis. Am J Occupational Ther 57:108–111CrossRefGoogle Scholar
  15. Genc H, Nacir B, Duyur Cakit B, Saracoglu M, Erdem HR (2012) The effects of coexisting fibromyalgia syndrome on pain intensity, disability, and treatment outcome in patients with chronic lateral epicondylitis. Pain Med 13:270–280PubMedCrossRefGoogle Scholar
  16. Hackel ME, Wolfe GA, Bang SM, Canfield JS (1992) Changes in hand function in the aging adult as determined by the Jebsen Test of hand function. Phys Ther 72:373–377PubMedGoogle Scholar
  17. Hodges PW, Moseley GL (2003) Pain and motor control of the lumbo-pelvic region: effect and possible mechanisms. J Electromyogr Kinesiol 13:361–370PubMedCrossRefGoogle Scholar
  18. Jebsen RH, Taylor N, Trieschmann RB, Trotter MH, Howard LA (1969) An objective and standardized test of hand function. Arch Phys Med Rehabil 50:311–319PubMedGoogle Scholar
  19. Jensen MP, Turbner JA, Romano JM, Fisher L (1999) Comparative reliability and validity of chronic pain intensity measures. Pain 83:157–162PubMedCrossRefGoogle Scholar
  20. Jones J, Rutledge DN, Jones KD, Matallana L, Rooks DS (2008) Self-assessed physical function levels of women with fibromyalgia: a national survey. Women Health Issues 18:406–412CrossRefGoogle Scholar
  21. Leeuw M, Goosens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen J (2007) The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 30:77–94PubMedCrossRefGoogle Scholar
  22. Lledó-Voyer A, Pastor MA, Pons N, López-Roig S, Rodríguez-Marín J, Bruehl S (2010) Control beliefs, coping and emotions: exploring relationships to explain fibromyalgia health outcomes. Int J Clin Health Psychol 10:459–476Google Scholar
  23. Lynch KB, Bridle MJ (1989) Validity of the Jebsen-Taylor Hand Function Test in predicting activities of daily living. Occup Ther J Res 9:316–319Google Scholar
  24. Mhalla A, de Andrade DC, Baudic S, Perrot S, Bouhassira D (2010) Alteration of cortical excitability in patients with fibromyalgia. Pain 149:495–500PubMedCrossRefGoogle Scholar
  25. Nacir B, Genc H, Duyur Cakit B, Karagoz A, Erdem HR (2012) Evaluation of upper extremity nerve conduction velocities and the relationship between fibromyalgia and carpal tunnel syndrome. Arch Med Res 43:369–374PubMedCrossRefGoogle Scholar
  26. Pantev C, Engelien A, Candia V, Elbert T (2001) Representational cortex in musicians: plastic alterations in response to musical practice. Ann N Y Acad Sci 930:300–314PubMedCrossRefGoogle Scholar
  27. Pfützner J, Hellhammer J, Musholt P, Pfützner AH, Böhnke J, Torsten H, Amann-Zalan I, Ganz M, Forst T, Pfützner A (2011) Evaluation of dexterity in insulin-treated patients with type 1 and type 2 diabetes mellitus. J Diabetes Sci Technol 5:158–165PubMedGoogle Scholar
  28. Pincus T, Vogel S, Burton AK, Santos R, Field AP (2006) Fear avoidance and prognosis in back pain: a systematic review and synthesis of current evidence. Arthritis Rheum 54:3999–4010PubMedCrossRefGoogle Scholar
  29. Pinkowski C (2002) Tests unter der lupe: pegtests a close look at standardized tests: peg tests. Ergotherapie Rehabil 41:17–22Google Scholar
  30. Reddon JR, Gill DM, Gauk SE, Maerz MD (1988) Purdue Pegboard: test-retest estimates. Percept Mot Skills 66:503–506PubMedCrossRefGoogle Scholar
  31. Rider B, Linden C (1988) Comparison of standardized and non-standardized administration of the Jebsen Hand Function Test. J Hand Ther 1:121–123CrossRefGoogle Scholar
  32. Robinson ME, Craggs JG, Price DD, Perlstein WM, Staud R (2011) Gray matter volumes of pain-related brain areas are decreased in fibromyalgia syndrome. J Pain 12:436–443PubMedCrossRefGoogle Scholar
  33. Skinner DK, Curwin S (2007) Assessment of fine motor control in patients with occupation-related lateral epicondylitis. Man Ther 12:249–255PubMedCrossRefGoogle Scholar
  34. Smeulders MJ, Kreulen M, Bos KE (2001) Fine motor assessment in chronic wrist pain: the role of adapted motor control. Clin Rehabil 15:133–141PubMedCrossRefGoogle Scholar
  35. Sterling M, Jull G, Wright A (2001) The effect of musculoskeletal pain on motor activity and control. J Pain 2:135–145PubMedCrossRefGoogle Scholar
  36. Stern EB (1992) Stability of the Jebsen-Taylor Hand function test across three test sessions. Am J Occup Ther 46:647–649PubMedCrossRefGoogle Scholar
  37. Sullivan MJ, Thorn B, Haythornthwaite JA, Keefe F, Martin M, Bradley LA, Lefebrve JC (2001) Theoretical perspectives on the relation between catastrophizing and pain. Clin J Pain 17:52–64PubMedCrossRefGoogle Scholar
  38. Tiffin J, Asher E (1948) The Purdue Pegboard: norms and studies of reliability and validity. J Appl Psychol 32:234–247PubMedCrossRefGoogle Scholar
  39. Turk DC, Robinson JP, Burwinkle T (2004) Prevalence of fear of pain and activity in patients with fibromyalgia syndrome. J Pain 5:483–490PubMedCrossRefGoogle Scholar
  40. VanVoorhis WCR, Blumentritt TL (2007) Psychometric properties of the Beck Depression inventory-II in a clinically-identified sample of Mexican American adolescents. J Child Family Studies 16:789–798Google Scholar
  41. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, Tugwell P, Campbell SM, Abeles M, Clark P (1990) The American College of Rheumatology 1990 criteria for classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 33:160–170PubMedCrossRefGoogle Scholar
  42. Wolfe F, Clauw DJ, Fitzcharles MA, Goldenberg DL, Katz RS, Mease P, Russell AS, Russell IJ, Winfield JB, Yunus MB (2010) The American College of Rheumatology preliminary diagnostic criteria for fibromyalgia and measurement of symptom severity. Arthr Care Res 62:600–610CrossRefGoogle Scholar
  43. Yancosek KE, Howell D (2009) A narrative review of dexterity assessments. J Hand Ther 22:258–269PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Marta Pérez-de-Heredia-Torres
    • 1
  • Rosa M. Martínez-Piédrola
    • 1
  • Margarita Cigarán-Méndez
    • 2
  • Ricardo Ortega-Santiago
    • 1
  • César Fernández-de-las-Peñas
    • 1
    • 3
  1. 1.Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical MedicineUniversidad Rey Juan CarlosAlcorcónSpain
  2. 2.Department of PsychologyUniversidad Rey Juan CarlosAlcorcónSpain
  3. 3.Facultad de Ciencias de la SaludUniversidad Rey Juan CarlosAlcorcónSpain

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