This presentation is about the etiology, symptoms and management of claw hand

1. CLAW HAND

2. ULNAR NERVE
FLEXOR CARPI ULNARIS
FLEXOR DIGITORUM
PROFUNDUS(M HALF)
HYPOTHENAR(FDM, ADM,
ODM)
4 PALMAR INTEROSSEI
4 DORSAL INTEROSSEI
2 MEDIAL LUMBRICALS
FLEXOR POLLICIS BREVIS
ADDUCTOR POLLICIS

3. MEDIAN NERVE SUPPLY
ABDUCTOR POLLICIS
BREVIS
FLEXOR POLLICIS
LONGUS
FLEXOR DIGITORUM
PROFUNDUS( L HALF)
FDS
FLEXOR POLLIS BREVIS
OPPONENS POLLICIS
1 ST AND 2ND
LUMBRICALS

4. CLAW HAND:
• Claw hand is an abnormal hand position that develops
due to a problem with the ulnar nerve or, Both ulna and
median nerve.
• A hand in ulnar claw position will have the 4th and 5th
fingers extended at the metacarpophalangeal joints and
flexed at the interphalangeal joints.
• The patients with this condition can make a full
fist(punch) but when they extend their fingers, the hand
posture is referred to as claw hand..

5. TYPES OF CLAW HAND
• partial: • Involving only ulnar 2 digits as in isolated
ulnar nerve palsy
• Complete • Involving all digits and resulting form
combined ulnar and median nerve palsy.

6. PATHOGENESIS
• An ulnar claw may follow a ulnar nerve lesion
which results in the partial and complete
denervation of the ulnar 2 lumbricals of the hand.
• It innervates the 3rd and 4th lumricals which flex the
MCP joints . Its palsy results in extension by
unopposed action of long finger extensors( ED,
EDM)
• Lumbricals and interossei also extend the IP joints.
Palsy results in weakened extension.
• Combination leads to claw like appearance

7. CAUSES
• CONGENITAL
• ULNAR INJURY AT ELBOW: not a true claw hand
• WRIST INJURY( FDP and FDS not paralysed; ulnar
paradox)
• PARALYSIS OF ULNAR AND MEDIAN NERVE
• LEPROSY
• SCARRING AFTER SEVERE BURN OF HAND/
FOREARM

8. SIGNS AND SYMPTOMS
• Hyperextension at the metacarpophalangeal
joints
• Flexion at IP joints.
• Loss of abduction/ adduction of fingers
• Wasting of thenar and interosseous muscles
• Numbness in the distribution of involved
nerves
• Funtional disabilities

9. DIFFERENTIAL DIAGNOSIS
• Volkmanns contracture
• Intrinsic muscle contracture
• Dupuytren’s contracture
• Spastic hand
• Congenital flexion contracture
• Peripheral neuropathy

10. MANAGEMENT
• SURGICAL:
• Nerve repair / decompression when possible is the
treatment of choice
• Tendon transfer( if nerve is unrepairable)
• POSTOPERATIVE MANAGEMENT:
• Immobilisation by dorsoulnar forearm plaster cast
including MCP joint which are flexed to 70
• After 2 weeks replacement of cast by thermoplastic splint
for the next 4 weeks
• Exercise for the finger and thumb