Location via proxy:   [ UP ]  
[Report a bug]   [Manage cookies]                
Scribd Logo
Upload

Welcome to Scribd!

  • 171 views

    Claw Hand

    Uploaded by

    Aditya Pratama Saanin
    This document summarizes information about claw hand, including its anatomy, etiology, clinical features, tests, and management. Claw hand is caused by damage to the ulnar and median nerves and results in flexion of the IP joints and hyperextension of the MCP joints. The document describes tests to evaluate ulnar and median nerve function and lists surgical procedures like tendon transfers and splinting that can be used to manage claw hand deformities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd

    Claw Hand

    Uploaded by

    Aditya Pratama Saanin
    171 views23 pages
    This document summarizes information about claw hand, including its anatomy, etiology, clinical features, tests, and management. Claw hand is caused by damage to the ulnar and median nerves and results in flexion of the IP joints and hyperextension of the MCP joints. The document describes tests to evaluate ulnar and median nerve function and lists surgical procedures like tendon transfers and splinting that can be used to manage claw hand deformities.

    Original Description:

    Claw hand, ulna, nervepalsi

    Copyright

    © © All Rights Reserved

    Available Formats

    PPTX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    This document summarizes information about claw hand, including its anatomy, etiology, clinical features, tests, and management. Claw hand is caused by damage to the ulnar and median nerves and results in flexion of the IP joints and hyperextension of the MCP joints. The document describes tests to evaluate ulnar and median nerve function and lists surgical procedures like tendon transfers and splinting that can be used to manage claw hand deformities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    171 views23 pages

    Claw Hand

    Uploaded by

    Aditya Pratama Saanin
    This document summarizes information about claw hand, including its anatomy, etiology, clinical features, tests, and management. Claw hand is caused by damage to the ulnar and median nerves and results in flexion of the IP joints and hyperextension of the MCP joints. The document describes tests to evaluate ulnar and median nerve function and lists surgical procedures like tendon transfers and splinting that can be used to manage claw hand deformities.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 23
    At a glance
    Powered by AI
    The key takeaways are that claw hand deformity is caused by damage to the ulnar and median nerves, leading to weakness of the small muscles of the hand. There are complete and incomplete types, and it has many potential etiologies.

    The different types of claw hand deformity are complete, involving all digits, and incomplete, involving only the ulnar two digits.

    Some of the causes of claw hand deformity include traumatic injuries, compressive neuropathies, brachial plexus injuries, infections like leprosy, peripheral neuropathies, systemic diseases, drugs/toxins, hereditary conditions, ischemia, and nerve tumors.

    CLAW HAND

    Complied by:
    Aditya Pratama Saanin

    Advised by :
    Dr. Donny H. Hamid Sp.S

    Clinical Rotation in Neurology Department of RSUD Pasar Rebo


    Period of Desember 24th 2018 – January 25th 2019
    YARSI UNIVERSITY
    Anatomy
    • Muscles that inervated by Ulnar
    Nerve
    Muscles that inervated by
    Median Nerve
    DEFINITON

    • occur due to damage to the


    ulnar nerve and median
    nerve

    • hyperextension on MCP joint


    + flexion on IP joint
    TYPES OF CLAW HAND
    • Complete : Involving all digits and resulting from
    combined Ulnar and Median Nerve palsy

    • Incomplete : Involving only ulnar 2 digits as in


    isolated Ulnar Nerve palsy
    • Traumatic
    • Compressive neuropathy
    • Brachial plexus injury
    • Infective ( Leprosy, Polimyolitis )
    • Peripheral neuropathies
    • Systemic diseases ( DM, Uremia,
    ETIOLOGY Porphyria, Malignancies )
    • Drugs and Toxins (Leas, Arsenic,
    Dapsone, etc )
    • Hereditary (CMTD, Syringomyelia, Lipid
    storage diseases )
    • Ischemia
    • Primary Nerve neoplasm
    Patomecanism

    • 1. Weakness / paralysis in M. Interossei


    and M. lumbrical.
    • Wasting of interossei
    • Hypothenar wasting
    • Brittle nails
    • Abnormal sensation on fingers 4 or 5, usually on the
    sides of the palm
    Clinical • Numbness, decreased sensation
    Symptom •
    •
    Tingling, burning sensation
    Hand weakness
    • Pain and / or paresthesia such as tingling that
    radiates downward from the elbow to the arm until
    the ulnar border of the hand
    • Loss of hand sensation in the distribution of the ulnar
    nerve
    • Claw hand deformity that is typical of chronic lesions
    Physical Examination

    Range of
    Inspection Palpation
    motion
    TEST FOR ULNAR NERVE

    Flexor Carpi Ulnaris: When Dorsal Interrossei: The


    the wrist joint is flexed patient is asked to abduct
    against resistance, the hand his fingers against Card test for Palmar Interossei: A card is
    tends to deviate towards resistance inserted between the two fingers which are
    radial side kept extended. The patient is asked to hold the
    card by adducting these two fingers as tightly as
    possible. The clinician will try to pull the card
    out of his fingers
    • Abductor digiti minimi: Ask the patient to abduct the little finger
    against resistance. Inability to do so indicates ulnar nerve palsy

    • Flexor digitorum profundus: The middle phalanx of ring or little finger


    is supported and the distal IP joint is flexed against resistance. Failure
    to flex implies high ulnar nerve palsy

    • Sensation: There will be loss of sensation over the ulnar distribution


    (medial 1/3 of palm & dorsum of hand and ulnar one & half fingers)
    FROMENT SIGN
    (First Palmar Interossei
    and Adductor Pollicis)
    • The patient is asked to grasp a book
    between the extended thumb and
    the other fingers

    • But if the ulnar nerve is injured,


    these two muscles will be paralysed
    and the patient will hold the book
    by flexing the thumb with the help
    of flexor pollicis longus. This sign is
    known as “Froment sign”
    Clinical features of median nerve palsy
    • Thenar wasting
    • Simian or ape thumb deformity
    • Atrophy of pulp of index finger
    • Cracking of nails
    • Tropic changes
    • Wasting of lateral aspects of forearm
    • Flexor Pollicis Longus:

    • The patient is asked to


    bend the terminal
    phalanx of the thumb
    against resistance while
    the proximal phalanx is
    being steadied by the
    clinician

    • This muscle is only


    paralysed when the
    median nerve is injured
    at or above the elbow

    TEST FOR MEDIAN NERVE


    • Opponens Pollicis:
    -This muscle swings the
    thumb across the palm to
    touch the tips of the other
    fingers
    -The patient with paralysis
    of this muscle will be
    unable to do this
    movement
    Oschsner’s clasping test
    Flexor Digitorum Superficialis &
    Profundus(lateral half):

    • If the patient is asked to clasp the


    hands, the index finger of the affected
    side fails to flex and remains as a
    “Pointing Index”
    Management of deformed hands
    • Exercises-physiotherapy

    • Splinting:
    -- To immobilize all or part of a hand in a position that will promote healing and
    prevent deformity
    -- To correct an existing deformity and promote function in that part
    -- To supply power to compensate for weakness

    • Surgical correction:
    -- Active or dynamic procedure: Called so because they bring extra active muscular
    forces in places of those lost because of muscle paralysis

    -- Passive or static procedure: Called so because they attempt to restore equilibrium


    without introducing new active muscle forces
    Non-progressive or
    Irreparable nerve slowly progressive
    damage neurological
    Indications
    disorders
    for tendon
    transfer
    Loss of function of
    a
    musculotendinous
    unit
    • Modified bunnell technique
    • Brand technique
    Operations for the • Fowler
    • Srinivasan’s Extensor Diversion Graft
    restoration of operation
    intrinsic function • Zancolli technique
    of fingers • Fowler’s Tenodesis
    • He devised a technique using
    the extensor carpi radialis
    brevis tendon lengthened by
    a free graft from the
    plantaris tendon

    Brands transfer
    Srinivasan’s Extensor Diversion Graft operation
    • to divert part of the
    excessive extensor force
    acting on the MCP joint &
    causing hyper-extension of
    the same towards its flexor
    aspect
    • The advantage of this
    operation is that, it is
    technically less demanding
    than brand’s operation and
    fingers can be individually
    corrected
    • Elliptical segment of
    volar
    fibrocartilaginous
    plate is resected
    Suture the volar
    plate with heavy
    silk; If desired insert
    transarticular ‘K’
    wires to maintain
    position of the joints
    Zancolli’s capsulodesis
    Thank you

    You might also like