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Ulnar Claw Hand

Catherine Curtin Associate Professor Plastic Surgery

What is going on?

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Intrinsic Muscles

What’s going on?

! Intrinsics weak or paralyzed ! MP Hyperextension ! PIP Flexion ! Thumb/pinch dysfunction

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Froment sign

! Compensation of pinch with FPL

www.ehealthstar.com

Wartenberg sign

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Possible causes?

! Low Ulnar Nerve Palsy?

Possible causes?

! Low Ulnar Nerve Palsy? – Yes – Cubital Tunnel – Nerve Injury from mid forearm distal

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Possible causes?

! Low Ulnar Nerve Palsy ! High Ulnar Nerve Palsy?

Possible causes?

! Low Ulnar Nerve Palsy ! High Ulnar Nerve Palsy?

– No – Extrinsic Flexors are out and can not flex IP

joints

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Possible causes?

! Low Ulnar Nerve Palsy ! High Ulnar Nerve Palsy ! Medial Cord Injury

Possible causes?

! Low Ulnar Nerve Palsy ! High Ulnar Nerve Palsy ! Medial Cord Injury

– Sort of – Results in complete Claw hand as median

innervated intrinsics also out

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Complete Claw Hand

Possible causes?

! Low Ulnar Nerve Palsy ! High Ulnar Nerve Palsy ! Medial Cord Injury ! Neurogenic TOS

– Same as medial cord injury

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Pause

! Complete Claw Hand

! Often misdiagnosed

Treatment

! Fix the nerve? – Cubital Tunnel Release – Nerve Repair

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Nerve Transfer

! AIN to ulnar motor – Bring axons to

intrinsic muscles – Only 700 axons in

AIN – High ulnar nerve

injuries

Splinting

! Anti claw splint – Keep MP Flexed – Allow PIP flexion

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Tendon Rebalancing

! Claw of MP joints options – Zancolli lasso – Stile’s-Bunnel

http://www.josonline.org/pdf/v23i1p15.pdf

Static Procedures

! Volar Plate Advancement

! Tenodesis Procedures

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Volar Plate Advancement

Thumb

! New Zealand Lasso-Split FPL Transfer

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Thank you