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A hand imitating an ulnar claw. The metacarpophalangeal joints of the 4th and 5th fingers are extended and the Interphalangeal joints of the same fingers are flexed.. An ulnar claw, also known as claw hand or Spinster’s Claw, is a deformity or an abnormal attitude of the hand that develops due to ulnar nerve damage causing paralysis of the lumbricals.
There are different types of acquired hand deformities, each with distinct characteristics and underlying causes, such as boutonnière deformity, Dupuytren's contracture, gamekeeper's thumb, hand osteoarthritis deformity, mallet finger, swan-neck deformity, ulnar claw hand, among many others.
Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is ulnar neuropathy at the wrist where it passes through the ulnar tunnel (Guyon's canal). [1] The most common presentation is a palsy of the deep motor branch of the ulnar nerve causing weakness of the interosseous muscles .
The claw hand deformity is more prominent with injury at the wrist as opposed to a lesion higher up in the arm, for instance, at the elbow, as the ulnar half of the flexor digitorum profundus is not affected. This pulls the distal interphalangeal joints of the 4th and 5th digit into a more flexed position, producing a more deformed 'claw'.
In contrast, when ulnar neuropathy occurs at the wrist (ulnar tunnel syndrome), motor symptoms predominate. There may be an ulnar claw hand from imbalance between the muscles innervated by the ulnar nerve in the forearm (which are functioning normally) and those in the hand (which are weak). The back of the hand will have normal sensation. [1]
This commonly results from weakness of some of the ulnar nerve innervated intrinsic hand muscles-in particular the palmar interosseous muscle to the little finger- caused by damage to their nerve supply (denervation). There may be different causes for this denervation and muscle imbalance including:
The hand of benediction, also known as benediction sign or preacher's hand, has been said to occur as a result of prolonged compression or injury of the median nerve at the forearm or elbow. [ 1 ] More recently it has been shown that the clinical appearance of a high median nerve palsy is different from the classical hand of benediction or ...
Cubital tunnel syndrome is an ulnar neuropathy that can be caused not only by compression at the cubital tunnel level itself, but can also be caused by movement of the elbow. [1] The volume of the cubital tunnel may be reduced when being moved from full extension to a lesser degree of flexion. Symptoms may include a claw hand. [4]