Nerve Injury Position of the Hand & Fingers - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубликовано: 19 авг 2024
- Dr. Ebraheim’s educational animated video describes positions of the hand and fingers that may identify possible nerve injuries.
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When you examine a patient with a nerve injury, if you look at the hand, you may be able to determine what kind of nerve injury the patient may have. And an ulnar nerve injury, you may have a claw hand, you may have Wartenberg's sign, the patient may not be able to cross the fingers and you may have wasting of the first interosseous muscle. Injury to the ulnar nerve may produce a clawhand deformity, especially if the injury is below the elbow. The flexion of the fingers or the clawing of the fingers occurs due to a functional flexor digitorum profundus muscle for the fourth and fifth fingers (the FDP is working for these fingers). The flexor digitorum profundus takes over and causes clawing of the fingers. When the hand is relaxed or extended the claw appearance disappears. In the distal ulnar nerve injury, you lose innervation to all of the interossei in the ulnar 2 lumbricals.Wartenberg's sign is and abduction of the fifth finger. Wartenberg's sign is due to an ulnar nerve injury and consist of abduction of the fifth finger, caused by an unopposed action of the ulnar insertion of the extensor digiti quinti (radial nerve innervated muscle). The unopposed action of the extensor digiti quinti muscle causes the finger to rest in a more abducted position.
Why does Wartenberg's sign happen? It occurs due to paralysis of the palmar interosseous muscle that abducts the little finger. The patient will be unable to cross the middle and index finger as a result of ulnar nerve injury. Abduction of the fingers come from the dorsal interossei (DAB).
Froment's test is used frequently to test for palsy of the ulnar nerve which may occur with entrapment of the ulnar nerve within the cubital tunnel (cubital tunnel syndrome). Formant sign is a test for the ulnar nerve. When pinching a piece of paper between the thumb and index finger, the thumb IP joint will flex if the abductor pollicis muscle is weak due to an ulnar nerve palsy. The anterior interosseous nerve is of branch of the median nerve. The "hand of benediction "is seen in patients with a high median nerve injury. The "sign of benediction" is an active sign that occurs when a patient with a high median nerve injury is trying to make a fist. In the sign of benediction (due to high median nerve injury) there will be paralysis of the FDS, the FPL, the FPB and the radial half of the FDP. So, the only remaining flexor that is functioning is the ulnar half of the FDP, which resulted in flexion of digits 4 and 5, while the other digits remain extended. The first and second digits will have difficulty in flexing, will the other digits (4 and 5 digits) will flex. The third digit appears to be weak. Hand will assume the Benedictine sign or sign of benediction. Ulnar claw hand refers to damage to the ulnar nerve
below the elbow and is seen when the patient is attempting to extend all the digits (leaving the fourth and fifth digits flexed). In a normal hand at rest, digits 2 through 5 assume a mild flexion position and all will be in the same dorsal ventral plane due to the action of the thenar muscles. In a median nerve injury, the thenar muscles are paralyzed so the thumb will be pulled more dorsal by the action of the adductor pollicis, which is an ulnar nerve innervated muscle. The thumb will be in the same plane as the other digits. All the digits lined up in the same dorsal ventral plane resembles the hand position of lower primates, which is why they called this "ape hand."
The O.K. sign Patients with paralysis of the anterior interosseous nerve will be unable to make the okay sign. This occurs due to paralysis of the FPL muscle and the lateral part of the flexor digitorum muscle (both are innervated by the anterior interosseous nerve).
High radial nerve palsy (upper arm to elbow)
Injury to the radial nerve will cause wrist drop. High radial nerve injury is usually occur due to fractures of the distal third of the humeral shaft.
Holstein-Lewis fracture
The fracture will cause injury to the radial nerve which will result in paralysis of the wrist and finger extensors (22%). The patient will not be able to extend the wrist, fingers or the thumb (occurs in about 20% of patients). The patient will not be able to hitchhike or do finger extension.
Low radial nerve palsies (below elbow)Low radial nerve injury usually occurs around the elbow and it will affect fingers and thumb extension (posterior interosseous nerve injury). If the patient does not have a wrist drop and still cannot perform the hitchhike sign, and check the patient for posterior interosseous nerve injury. Recovery of wrist extensors, but the finger extensors are not yet recovered is a sign of posterior interosseous nerve injury that has not recovered yet.
![Hand of Benediction vs the Claw Hand [feat. the Ulnar Paradox]](http://i.ytimg.com/vi/BWhB_B3e4gc/mqdefault.jpg)
![Hand of Benediction vs the Claw Hand [feat. the Ulnar Paradox]](/img/tr.png)
All respect Prof. Nabil , I turned on notifications for videos to avoid missing any of your easy-illustrated lectures, Thanks alot for your efforts!
Dear Prof, there is mistake in video, on 1:30 you said claw is made when person tries to flex finger and on 6:45, you say claw is formed when person tries to extend. I think second is correct. Thank you.
Thank you very much sir. I have exams in a few days and opening the book for nerve injuries seemed so daunting now but this is such a wonderful,crisp recap of the topic!!
Thanks sir I'm a physiotherapist and this video help me very much...thank you doctor very much... I'm from Iraq
Thank you sir , your videos are very very helpful for my occupational therapy class!!
thanks
yes it was helpful. Educative and simple.
I am so glad I know this channel. Thank you Dr Nabil Ebraheim for sharing your knowledge with us.
Going out to all the people suffering serious nerve damage this is so painful. I had acute compartment syndrome. Therefore had an emergency facioatomy.
Of the forearm and hand
What does this mean? "The claw hand is a permanent position of the hand at rest and it is seen only when there is an active attempt to flex the fingers." I agree that the claw hand is a permanent position of the hand at rest. Is it supposed to be seen only if when there is an attempt to extend the fingers?
This lature is useful for normal people also. Thank you... Sir.
Very helpful thank you but the word recovered at the end of the video was missing the second r. A typo error I'm sure.
Yes, it is helpful, thank you Doctor 😊
Sir same problem me please how to cure help 🙏😭meee
Tuje huha thik ki nhi bhai muje bhi same problem h
Sir may right hAnd is claw hand please I'm indian please video for claw hand full treatment
how can I get this doctor? please
Marvellous
8.29
Inability to perform OK sign is mainly due to paralysis of FDP.
Also at 3:00 of this video, "It occurs due to paralysis of the palmar interosseous muscle that ABDUCTS the little finger." Should be ADDUCTS.
Very good
Coming into my third year with this. Just need to figure out how to safely lift weights again
Claw hand treatment why please new video eaxarcies dr sir g
Thank you it was very helpful
Thanks, concerning management and electrodiagnosis : wait and see or surgical intervention?
Thank you
Great vid, thank you.
I need to have surgery to reattach the tendon after a bicep rupture. I understand there is a risk of damage to the PIN nerve but would this be permanent or can mobility be recovered?
Im get worse after surgery nerve repair now i need another surgery because my status after distal portion radial side ulnar nerve ring finger, index middle finger,plus digital radial nerve graffing was affected whith neuroma formation
I have wrist drop and claw hands problem since 2011 and there is no fine solution in Pakistan of this.. please help me to get out of this problem.
Perfect! Thank you for this!
How to cure this problem sir.....and how much money is needed for this problem to Recovery sir please help me sir..... please please please sir......reply me sir please 😭
please help me I need this doctor
Same problem to me😢
But no one give the correct solution
How to recover it. Please help me.
Thank you Prof
Excellent video. I have neurological damage in my left hand and I cannot raise my wrist and 4 of my fingers are 90% closed all day and it will not open.. please help me.
How are you now?
Great video thank you so much!
Very informative!
Sir, I am suffering from same problem with right hand fingers. Please suggest treatment or exercises to recover.
Hi number send me mera bhi same hai
Please for 2months now I can’t make the ok sign and many more
thank you doctor
Hlo sir i am suffering from single sided hip dip problenm i.e. internal depression around right hip only( not on left hip) plz help in knowing the cause and solutions😊
Both my hands Shake turn red all over and my fingertips and my thumbs are very sore and a lot of shaking I have a herniated disc on a 01 S1 and severe authorization in the neck and calcium on the left sit bone
Thankyou so much
Sir same problem plz sir help me
Brillaint.
Please Dr tell us what can we do with this problem .
I have same problem
l need to see dr nabil
Sir is hand getting Thinner for claw hand ... cause I'm suffering from this
hello Doctor, please assist. The first half of the video says the ulnar claw disappears on active extension of the fingers, but the second half if the video says it appears on active extension. I'm not sure if I'm a little confused. Thank you.
yes! conflicting information on the claw hard. @1:30 he mentions the claw disappears when extended. Then @6:34 he says it appears when extended.
Sir what is the treatment of this hand
I was shot 6 times in my thigh and arm my nerves connection in my hand is slow
i thought i was gonna die and IT HURTED ALOT HAVE TO SUFFER IT 4x
My hand is nerve problems give me medical address plz
Sir I am facing this problem since 16 years
Is it From brain someyimes too like neuroleptics?
Dr pls treatmant this dieses
It most certainly doesn’t disappear when your hand is relaxed. Shits clawed 24/7
🔥🔥🔥🔥
আমি বাংলাদেশ থেকে জানতে চাচ্ছি,, ডাঃ নাবিল ইবরাহীম, কোন দেশের চিকিৎসক,, এবং তার চেম্বার কোথায়,, দয়া করে অনুগ্রহ করে,আমার কমেন্টের উত্তর দিবেন,Please sar,
ভাইয়া ড.নাবিল এর কোন নাম্বার পেলে আমাকে প্লিজ জানাবেন
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Only cure is surgery
Thank you