INTRODUCTION: The split-hand concept has highlighted the preferential wasting of the thenar side of the hand in amyotrophic lateral sclerosis (ALS). Our objective is to re-explore pinch grip strength to assess whether it has the potential to be a practical biomarker of ALS. METHODS: We measured different pinch grip strengths (thumb, index and fifth) using a pinch gauge from both hands of 54 ALS patients and correlated this with the Medical Research Council (MRC) score, the upper-limb component of the revised ALS functional rating scale (ALSFRS-R) score, and compound muscle action potentials (CMAPs) that comprise the split-hand index. RESULTS: Pinch grip strength using any of the three fingers showed a positive correlation with its corresponding CMAP, MRC grading and upper-limb ALSFRS-R score. The thumb pinch showed the strongest correlation with the split-hand index and MRC grading. DISCUSSION: Pinch grip strength test using a simple gauge deserves further study as a potentially practical biomarker of ALS.