Claw Hand, Ulnar Claw Hand - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубликовано: 30 июл 2017
- Dr. Ebraheim's animated educational video describing clawing of the hand - Ulnar Claw Hand.
Ulnar claw hand is an abnormal hand position that develops due to injury of the ulnar nerve. The ulnar claw hand deformity occurs more with a lower ulnar nerve lesion (below the elbow) and typically causes flexion and clawing of the 4th and 5th fingers due to the unopposed action of the medial part(ulnar part) of the flexor digitorum profundus muscle.
Clawing is seen when the patient is asked to extend the fingers. A hand in ulnar claw position will have the 4th and 5th fingers extended at the metacarpophalangeal (MCP) joints and flexed at the interphalangeal (IP) joints. When you ask the patient to extend the fingers, the patient will not be able to extend the interphalangeal (IP) joints of the fourth and fifth fingers.
Why does this happen?
The ulnar nerve innervates the ulnar ½ of the flexor digitorum profundus muscles. The ulnar nerve also innervates the 3rd and 4th lumbrical muscles, all of the interosseous muscles, the adductor pollicis muscle, and the deep head of the flexor pollicis brevis.
When there is an injury to the ulnar nerve at the wrist, there will be loss of function for all the interosseous muscles and the ulnar two lumbricals.
The second and third digits are mainly unaffected by this injury except in adduction and abduction of the fingers, while the fourth and fifth digits are largely affected by injury to the nerve. With this dysfunction of these muscles, the extensor digitorum is unopposed, causing hyperextension of the fourth and fifth digits at the metacarpophalangeal (MCP) joints.
The extensor digitorum is very affective in extending the MCP joint. The extensor digitorum gets help from the interossei and the lumbricals to extend the IP joints through the extensor hood or the extensor expansion. At the interphalangeal (IP) joints, the extensor digitorum has to overcome and counteract the flexion force that is exerted by the functional flexor digitorum profundus. Clearly the extensor digitorum cannot do this because there is no assistance from the lumbricals or the interossei muscles (clawing of the fingers will show up).
This usually occurs from a distal ulnar nerve lesion that preserves innervation to the medial half (ulnar half) of the FDP muscles. In this distal lesion, the sensation at the dorsum of the fourth and fifth fingers will be intact because the dorsal sensory nerve may be spared if the lesion is at the wrist. There will definitely be numbness of the fourth and fifth fingers on the volar aspect. You may find wasting of the first interosseous muscle. There may also be flattening of the hypothenar eminence.
The fourth and fifth fingers will be stuck in a position of hyperextension at the MCP joints and flexion at the IP joints. If lesion of the ulnar nerve is high and the flexor digitorum profundus is not working, then there will be no clawing of the fingers. Definitely in a high ulnar nerve lesion, there will be a loss of sensation in the dorsal aspect of the fourth and fifth fingers.
Differential Diagnosis:
•Volkmann’s Ischemic Contracture
•Dupuytren’s Contracture
•Spastic Hand
•Congenital Flexion Contracture (camptodactyly)
These two conditions may appear similar however they are not the same! Claw hand occurs due to an ulnar nerve injury, usually a distal lesion. This is how the position of the hand appears. The fourth and fifth digits are flexed and the patient cannot straighten these two fingers.
Sign of Benediction
The sign of benediction usually occurs due to a median nerve injury, usually a high median nerve injury or anterior interosseous nerve lesion. The sign of benediction is the position of the hand that occurs when you ask the patient to make a fist and the second and third fingers will remain extended. When you ask the patient to extend the fingers, they will be able to extend them. They cannot flex the second and third digits and also cannot do the ok sign. This is a median nerve or anterior interosseous nerve injury.
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This video explained everything so well that it is impossible to not understand!
Thank you
Damn. Never thought a day would come when i'll finally understand this concept lol
He is really very, very good
This was excellent Dr Ebraheim I watched it for the sake of study for a Clinical Exam in Melbourne.Realy made me revise clearly. My son had an accidental cut to his wrist when he was like 10 years old and was critical from this injury with a cut to the tendon, nerve and Ulnar Artery however he had Microsurgery in a small country by a realy talented surgeon and he recovered well.However I can see that there is slight clawing of his fingers the Ring finger and the little finger. He is 30years now!! God Bless.
You have uploaded this video 3 years ago, after 3 years It's still better than thousand medical videos. Thank you.
Thank you Dr. Ebraheim, all of your videos are of excellent caliber and very educational and helpful.
your videos are extremely clear and expertly explained. thank you - they have been tremendously helpful
Dude, SUper helpful!!! Been stuck on these two for a long time. Your enunciation and clear wording of cause and S&S were SUPER helpful. Thank you!
Great Thanks our Professor
Your great effort is much appreciated
Love how you differentiated claw hand from hand of Benediction✨💯. It can be confusing and not all textbooks specifically differentiate them.
Imagine my surprise when I'm a med student at the university of toledo trying to remember this for my MSK quiz tomorrow and this is the first video that pops up! Thanks Dr. Ebraheim!
Very helpful! Thank you so much!
Thank you embarrassing but I was literally clawing my hand so confused as to how this would work. Then you showed how the hand position would actually be and it makes much more sense! Thanks!!!
Excellent explanation thank you Dr.Nabil
As always thank you Dr Ebraheim. this was always impossible to understand, but not now!
Wonderful! I'm glad you're teaching medicine in a manner that one can logically understand it
This was such a great explanation!! I'm in anesthesia school and this was described leaps and bounds better than my boards prep material. Thank you
Excellent tutorial
Yes,you were helpful.
so good!! Thanks
VERY VERY informative..Thank you ❤❤❤❤❤❤
Thank you dr Nabil.. This was extremely helpful
Very good to study. Thank so much teacher!!!!!
Excellent video! Thank you!
Excellent video sir ; thanks a lot !
Thanks Dr. Shb.
Jazak ALLAH (SWT)
Thankyou Doctor, is very clear and helpfull.
Superb... well explained.
If you have this problem, don't be worried. I have this since i was 16 yrs old now i am 27 Years.... I still have a perfert life... I just don't have to work like other people... I m not the luckiest person in the world but i m not the unluckiest person either... So ignore your looks and strength in your hands, you will be just fine...
Hi I also have this now. Please can we connect? So that I can learn many things from u related to this
I got this from an elbow injury (tennis elbow)
I do things in my hand🙂 especially my dream
@@kinchitbajaj6972 hi I have also same problem can we connect??
I just got this about two years ago work accident I'm explaining to workers comp and doctors they don't understand I have numbness tingling and it gets worse the more I do 😧
Thank you!
very clear and excellent explanation thank you doctor
Great vedio s ..you’re the best
Very Helpful
What a legend!
What was the solution for me
Thank you sir.
Brilliant... all your videos are too good.... excelent clarity of explanation... please upload more and more vidoes
Thank you.
Thank you❤
To anyone who has this, if you have had a direct injury to the Ulnar nerve and its serious you will end up with this hand. The more Proximal (meaning closer to the neck or further up the longer the recovery is) if you have this you must be evaluated immediately by a Neurologist or hand Surgeon to find the exact location of the ulnar nerve injury.
The quicker to surgery the better, there is no physical therapy for this. If you have an injury whether a cut or a compression you will need a AIN nerve Transfer in the forearm so that the nerve axons can reach the hand quicker as the native or original nerve recovers.
But do be warned even if you the surgery in the first 3 months and you have this hand you will expect to see change in minimum 18 months and if it's at the elbow or near you will need the AIN nerve transfer otherwise you will not have enough time to reach the the hand as the muscles die after 24 months of no stimulation from a nerve.
Dr Nabil will not answer any questions nor give advice, he just puts up videos but you can ask me questions anytime.
First step a good Neurologist then a good nerve or hand surgeon.
My left arm was cut at my elbow on my ulnar nerve a few years ago but just now finally getting insurance, i have the claw hand and it’s hard to feel anything. Is there any hope of having surgery and hopefully some what having normal functions in my hand? At first it was a huge amount of pain. But eventually all the feeling went away. Muscle wasting has happened and my left hand is skinner then the other where it claws. I really hate it... is there any hope for any type of movement someday?
@@JayJay0_420 Thanks for reaching out. If it has been several years since the nerve has been cut it means that the muscles that work the hand have probably completely wasted away.
What can be done as there are surgeries for sensation so there are nerve transfers for that but to correct the claw it will be a Tendon Transfer to stop that which will give some normal function but not like it was before.
Why was it not assessed in the beginning?
I have the same condition that happen through physical injury. I didn’t have insurance at the time 2020 however it’s just my left pinky that’s slightly crooked . I can still move my pinky and feel slight sensations on my pinky however is there anything I can do now that I’m financially able?
@@jarrettwilson1347 Leaving this comment here so I get notified of replies. Similar situation here.
Hi, 2 months before I had GBS and after which i have this claw hand. Not sure as to whom to approach to get rid of it and I m not even sure if I ll get through this. Can u pls help me on this
very clear explanation
Extraordinary.
Simply excellent. Very grateful for clear, concise and well presented video. Thank you for the great channel. 6/8/2018 😊
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😐
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Very helpful 👍
Sooooo helpful🙏🏻🙏🏻🙏🏻
Thank u it was really help full
Thank you x
you were very helpful
Thanks your are veryyy helpful
Thanku so muchhh sirrr🙏🏻🙏🏻
Thanks sir🙏🏻 useful.
thank you so much it was great as always
Thank you for your videos. They helped me understand what has happened to me and the visuals were very useful. I did a race almost two weeks ago (my 10th Ironman) and noticed that my hand went numb during the bike portion. I thought it was my bad shoulder (rebuilt after an accident) and kept moving around on the bike, changing hand positions between my regular bars and aero bars, and the numbness persisted. I finished the race and thought my hand would be fine when I woke up in the morning. It wasn't. I could not easily button my pants, my little finger/ring finger and palm were still numb for 1/2 of my hand, and my thumb felt clumsy (couldn't grip, put a top on a bottle well, etc). I cannot straighten the little or ring fingers, either. I went to urgent care and they referred me to a neurologist. The neurologist did an EMG and found my ulnar nerve to not be functioning normally at all- both sensory and motor. He thought the problem was in my elbow. I went to the hand surgeon and he suggested moving the nerve in my elbow because that is "usually" where the problem is. (I am a chemist. I like to see evidence, so that makes me uncomfortable.) The top of my hand feels normal to touch, which seems to indicate the problem is not at the elbow. I'm confused as to if the nerve is really impinged at the elbow or somehow I may have created a compression that damaged the nerve while on my bike that needs time to heal (can it?). . . Is it possible to figure out whether it is an ongoing problem or the result of one damaging incident? If the top of my hand feels normal, could the problem even be in the elbow? I went from a completely normal hand to not being able to feel or move my hand well now for almost two weeks and am getting worried. Doing an MRI tomorrow, but the hand surgeon didn't sound hopeful about imaging being helpful for cause and wants to do the surgery to move the nerve. Any thoughts from anyone?
Cyndi Wells thanks for your comment. Have you had any luck with your recovery? I’ve started getting claw hand from riding, also. I have the exact same symptoms as you describe. I can wake up in the middle of the night with my arm completely dead. I’m starting to worry about it, also, so I’m getting a professional bike-fit done. I’m worried if I persist I may cause permanent damage
Plz tell me did you got it fixed...and how I m very depressed due to this problem I can't see any hope to get it fixed loosing my confidence..... Very disappointed due to this problem plz let me know
@@arymantyagi how long have you had this problem now?
I can help you with some information as I have it too.
@@ildikotuzes6183hiiiiiii
@@fizaanjum5642 yes how can I help you
Very very helpful😁
God bless you
Thank u 👌
Simple and easy👍
Thanks alot
Best lecture 👍
Helpful
What if you have had your ulnar nerve cut at the elbow? Is there any hope for feeling and the use of the pinky finger and ring finger ever coming back? I really hope so...
You are really really helpful thankyou seriously I really need this for study
How i do ? Please tell me
Great 👍
Thanks sir
Hi sir, May I know some exercises for ulnar never
Thnx a lot
Please tell me the treatment ???last 2 fingers
I find myself in a rather challenging situation. 20 years ago, I attempted to open a glass jar using my elbow, resulting in the jar shattering. Glass shards ended up embedded in my arm, just below the elbow, and I rushed to the emergency room for immediate attention. The doctor there performed a basic stitch on my hand.
The next day, my hand had swollen to the size of a balloon, prompting me to seek the expertise of a surgeon. To my dismay, they discovered that the initial doctor had left glass fragments inside my arm, and the main vein was left unattended. The surgeon did what they could, but the hematoma, which had compressed the ulnar nerve before the surgery, had already caused damage. This injury occurred about 20 years ago.
Now, I find myself dealing with what is commonly known as a "claw hand," albeit affecting only my little finger. I've lost sensation in my last finger and half of my ring finger, and the muscles in my hand have atrophied. To make matters more challenging, it's my left hand that has been affected, and I happen to be left-handed. Consequently, I've had to give up many pursuits in life, such as professional guitar playing, among others.
Lately, I've developed a deep passion for tennis, and despite the difficulties, I've been playing with this hand. This newfound passion has ignited a desire in me to explore options for repairing my hand. My primary concern is whether it's possible to repair the damaged nerve. The extent of the damage is uncertain, and I'm unsure about the steps to take for a proper evaluation and professional opinion on the feasibility of repairing such an injury.
I would be immensely grateful if you could provide me with any information or guidance on this matter. Thank you in advance for your assistance.
Thanks for your help and
Thanks for your video. This is exactly what I have going on with my right hand. Though I’m also having pain at the base of my thumb and slight weakness of my second and third digits. Was given a referral to ortho, so I’m gonna follow up with them.
thanx 👏👌
Thanks you
Million thx
Thank you ..its all happened about me sir how can recover it..pleas answer.
Sir..how to strong mobilization of pip joint and mcp joint.I had a minor accident and broken in the middle proximal phalanx of the ring finger of my hand after 50 days ago in remove cast but I can't really lift my fingers.
thank you. this is exactly what I have and docters didnt know
Same to me
Same disease my fingers affected please contact me 7894968375
I’m so thankful for this video I literally showed it to my ortho dr and he referred me to a plastic surgeon whom does hand reconstruction!!
Hello....have you experienced these symptoms
Could you plz tell me about which plastic surgeon do i need to go plzzz rply
Very helpful! Thank you for this explanation. You are the best! 22/12/2018 😃😃
u r also the best
I'm facing the same problem
Do u have this?
Thnx dr Ibrahim
Sir my 3 and 4th fingers of left hand are showing some burning sensation like when any part dipped inside chill(snow) then if we direct heat up like that feelings on little finger and another one on top to down , but I can bend them both ,only sensation is not normal ,,,plz reply bcz it fells as to cut them
Thankyou Love from Pakistan
May I ask, is there a treatment when 1st lumbrical has blown.
I can see it on my palm.
What to do? Thank you
I’m scheduled for the guyons release in a month. I have had all this coming in with an acute onset just 60 days ago. I have learned from all the physician’s advice that time is of the essence. But had I not had the NCV/EMG I would have had unnecessary cutting at the elbow,
a question... what happens after the treatment of the ulnar nerve injury at the elbow? fdp will start working after a while and then the claw hand occurs until full recovery of the nerve end? Am I correct , if not why?
Sir it is my problems this my left hand side of sorts fingers is band
Thank
I'm looking for why my middle finger is hard to open it clicks and ganglion on the back of hand not at wrist and on a nerve
I tried sign of benediction, my middle finger is slightly bending too.
What does it mean.
Thank you
I have same problem plz professor recommend a better Dr I need help plz help me
Thnk u ❤️
Although i can see this us quite an old video i thank you cor posting.
I awoke 3 weeks ago with both hands not responding however have been able to recover 90% of my right hand. My left hand is still essentially gone to me except for contraction and the 3rd and 4th fingers just wont move out od a claw.
sir ...my same problems . so please can yoh help me ,whata i doing?
I m suffering this problem. what is treatment ?
What is the treatment
Thank u thank u thank u 🌺🌺🌺
What is the treatment?
Flexor digitorum profundus flexes the mcp joint,, then why there is no opposition to extensor digitorum
please sir help me my hand same this problem
Dr. Ebraheim's good evening sir I have problem left hand 4th finger little pain during bending renaming normal so please advise me what type of exercises required ,
Thanking you sir,
Same disease on my right hand ring finger affected please help me
Congratulations
Is trembling in the hand common with Ulner Claw Hand?
What is a solution this problem