An ulnar claw , also known as claw hand , or ' Spinster's Claw' is an abnormal hand position that develops due to problems with the nerve ulnar. The hand in the ulnar claw position will have the fourth and 5th fingers extended on the metacarpophalangeal joint and flexed at the interphalangeal joint. The patients with this condition can make a full fist but when they extend their fingers, the posture is referred to as a claw hand. Fingers and pinky fingers usually can not extend completely to the PIP joint.
This is usually confusing with "Hand of Benediction", caused by proximal median nerve damage (at the elbow level).
Video Ulnar claw
Presentations
Patients who show ulnar claws are also very often unable to spread (kidnap) or pull together (adduct) radius against resistance. This happens because the ulnar nerve also conserves the palmar and the back of the interossei hand. Patients with this deficit will become easier to identify over time as the first dorsal dorsal muscle disorder is paralyzed, leaving a prominent groove between the thumb and forefinger.
Maps Ulnar claw
Pathogenesis
An ulnar claw can follow ulnar nerve lesions that produce partial or complete denervation of the two lumbrical ulnar (medial) of the hand. Because the ulnar nerves also innervate the 3rd and 4th lumbricals, which flex the MCP joints (alias knuckles), their denervation causes these joints to be prolonged by extensor action of the now-defeated fingers (the extensor digitorum and the extensor digits minimi). Lumbricals and interossei also extend the IP connection (interphalangeal) radius by inserting into the extensor hood; Their paralysis resulted in a weak extension. The combination of hyperextension in MCP and flexion in the IP joint gives the claw-like hands an appearance.
The Ulnar Paradox
The ulnar nerve also inhibits the ulnar (medial) half of the flexor digitorum profundus (FDP) muscle. If the ulnar nerve lesions occur more proximal (closer to the elbow), flexor digitorum profundus muscle may also be denatured. As a result, flexion of the weakened IP joints, which reduces the appearance of the hand like a claw. (In contrast, the fourth and fifth fingers are only paralyzed in a fully extended position.) This is called the "ulnar paradox" because it would normally expect a more proximal injury and thus weaken it to produce a more defective appearance.
Simply, since reinnervation occurs along the ulnar nerve after a high lesion, the deformity will worsen (FDP reinnervated) when the patient recovers - hence the use of the term "paradox". The simple way to remember this is: 'getting closer to Paw, the worse Claw'.
Ulnar nerve symptoms
The ulnar nerve extends from the shoulder to the hand, and damage to it produces ulnar claws. This is related to palsy, which is the result of peripheral neuropathy. There are various ways that nerve damage can occur. Leaning on the elbow can cause long-term wear due to prolonged pressure from upper body weight. Symptoms arising from leaning on nerves can include numbness and tingling of the fingers.
Work Cause
Public works such as cyclists, motorcyclists, and desk jobs extend movement and elbow elbows. This activity involves pressure into the palm of the hand, which causes cumulative damage to the nerves. When using a pizza cutter or similar hand tools that require downward pressure when used, applying the upper body weight to pressure the tool over time can cause damage to the nerves.
Risk in gender and BMI
Older men are more likely to have ulnar mononeuropathy than women without regard to BMI. 95% of women with a BMI of less than 22.0 have a higher risk of ulnar nerve damage than lack of "bearing" adipose, and external compression of the elbow is a more important cause of ulnar mononeuropathy in women than men. Both men and women with high grip strength, such as string musicians, are more susceptible to ulnar mononeuropathy, as are those with severe or ongoing ulnar nerve compression.
Treatment
Treatment except surgery may include physical therapy and rehabilitation of occupational therapy. Various movements can be recovered by using hand splints to stretch out damaged hands and prevent excessive stretching. Using a splint will initiate flexion in the metacarpophalangeal joint while also allowing extension and flexion of the interphalangeal joint, thereby increasing the range of motion.
A useful exercise will be anything that strengthens muscle and interosseous lumbricals. By exercising the fingers and thumbs individually in adduction and abduction movements in the prone position, the interosseous muscles gain strength. Exercises to strengthen lumbricals, strengthen the flexion of the metacarpophalangeal joints, and extensions to the beneficial interphalangeal joint. The repetitive movement of pronation and supination is also an effective exercise for rehabilitation. Pronation exercises and supination with a grip or screwdriver attachment will help stimulate the nerves. Lateral grip and repetitive grips can also be applied to supination and pronation.
Prevention
Preventive therapy is recommended to maintain the function of the fingers. This may include physical exercise, stretching, proper body function and myofascial release (massage, foam roller). The exercises focused on the forearm muscles, such as the extensor carpi ulnaris; extensor digitorum to antagonize flexion of the fingers.
Massaging the forearm muscles also relieves the tension that occurs with exertion. Stretching allows the muscles to be more flexible, reducing the disruption of the ulnar nerve supply to the fingers.
The so-called "Hand of Benediction" is caused by median nerve lesions. The hand will show hyper-extension of the metacarpophalangeal joint (MCP) of the unsold extensor digitorum as well as the weakened extension and flexion of the Interphalangeal (IP) joints of the 2nd and 3rd numbers (index and center ) Because of the deficit in the radial lumbrical and the lateral half of the flexor digitorum profundus. The pathogenesis is similar to ulnar clawing (relevant lumbrical loss and flexor digitorum profundus along with unsupported underarm extensor action), and median claws will look similar to ulnar claws when patients with median claws are required to make fist.
The following signs may be used to clinically distinguish the median nerve of the ulnar nerve clawing.
Dupuytren Contracting
Dupuytren's contracture is hand deformity due to thickening and fibrosis of palmar aponeurosis and finally contracture of the 4th and 5th digit. Functioning as a small hard nodule at the base of the ring finger, it tends to affect the ring and little finger as a palmar wrinkle and aponeurosis adherence to the skin. Finally the MCP and IP connections of the 4th and 5th digits become permanently folded. The appearance of these claws can be distinguished from ulnar claws in that the MCP is bent in Dupuytren but hyperextended in ulnar nerve injuries.
Klumpke's paralysis
Hand claws can cause injury to the inferior brachial plexus (C8 - T1). This condition can arise from the limbs that are suddenly pulled up. For example, Klumpke's paralysis may occur from excessive withdrawal of the infant forelimb during labor.
References
External links
- http://www.wheelessonline.com/ortho/intrinsic_weakness_and_claw_hand
Source of the article : Wikipedia
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