A decision-analysis model to diagnose feigned hand weakness.

Malingering is a condition in which patients exaggerate incapacity. Feigned hand weakness is one form of malingering, and it is often seen after work-related hand injuries. Malingering is prevalent in the workers' compensation system, which devotes a large proportion of valuable resources to unwarranted claims. Feigned hand weakness must be detected early because it is relatively prevalent and expensive to society. Clinical evaluation is the first step in detecting feigned hand weakness, but it is not very specific. Therefore, every suspected positive clinical result must be followed up with a more advanced test that has better specificity. Three advanced tests are (1) five-rung grip test, (2) rapid grip tests (rapid exchange grip and rapid simultaneous grip), and (3) computerized measure of grip. Among these, computerized measure of grip is the most specific; therefore, it is the best second-line test.