E-Pearl of the Week: Milkmaid Grip

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July 1, 2013

Milkmaid Grip

Huntington's disease is a progressive neurodegenerative trinucleotide repeat (CAG) disorder characterized by chorea, psychiatric disturbances, oculomotor dysfunction and cognitive decline. Motor exam often shows difficulty with fine motor skills and motor impersistence - the inability to maintain sustained voluntary contraction of a muscle group at a constant level. Inability to apply steady pressure during handshake leading to a characteristic squeeze and release of grip has been termed the milkmaid's grip (1). Similarly, patients have difficulty maintaining forced eyelid closure or sustained tongue protrusion. Motor impersistence occurs independently of chorea and has been shown to be linearly progressive over the course of disease suggesting a potential role as a surrogate marker of disease progression.


  1. Walker FO. Huntington's disease. Lancet 2007;369:218-228.
  2. Reilmann R, Kirsten F, Quinn L, et al. Objective assessment of progression in Huntington's disease: A 3-year follow-up study. Neurology 2001;57:920-924.

Submitted by Roy Strowd, M.D. Resident Physician, Wake Forest School of Medicine, Winston Salem, NC.

Dr. Strowd is a member of the Residents and Fellows Section of Neurology.

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