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

Flexor Carpi Ulnaris: When
the wrist joint is flexed
against resistance, the hand
tends to deviate towards
radial side
TEST FOR ULNAR NERVE
Dorsal Interrossei: The
patient is asked to abduct
his fingers against Card test for Palmar Interossei: A card is
resistance inserted between the two fingers which are
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”
 Non-progressive or
Irreparable nerve slowly progressive
damage neurological
Indications
disorders
for tendon
transfer
Loss of function of
a
musculotendinous
unit