Claw Hand, Ulnar Claw Hand - Everything You Need To Know - Dr. Nabil Ebraheim
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- Опубліковано 21 сер 2024
- 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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![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)
![Дон ДОН, Алаудинов и СБЕЖАВШИЕ из под Курска ахматовцы 😁 [Пародия]](http://i.ytimg.com/vi/dEfCf5IK26Q/mqdefault.jpg)
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.
Love how you differentiated claw hand from hand of Benediction✨💯. It can be confusing and not all textbooks specifically differentiate them.
You have uploaded this video 3 years ago, after 3 years It's still better than thousand medical videos. Thank you.
your videos are extremely clear and expertly explained. thank you - they have been tremendously helpful
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!
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
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
Thank you Dr. Ebraheim, all of your videos are of excellent caliber and very educational and helpful.
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
Wonderful! I'm glad you're teaching medicine in a manner that one can logically understand it
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 😧
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
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!!!
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!
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.
Great Thanks our Professor
Your great effort is much appreciated
Simply excellent. Very grateful for clear, concise and well presented video. Thank you for the great channel. 6/8/2018 😊
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As always thank you Dr Ebraheim. this was always impossible to understand, but not now!
Excellent explanation thank you Dr.Nabil
Brilliant... all your videos are too good.... excelent clarity of explanation... please upload more and more vidoes
Yes,you were helpful.
Thanks Dr. Shb.
Jazak ALLAH (SWT)
thank you. this is exactly what I have and docters didnt know
Same to me
Same disease my fingers affected please contact me 7894968375
Thank you dr Nabil.. This was extremely helpful
very clear and excellent explanation thank you doctor
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,
Very good to study. Thank so much teacher!!!!!
Very helpful! Thank you so much!
VERY VERY informative..Thank you ❤❤❤❤❤❤
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.
Excellent tutorial
You are really really helpful thankyou seriously I really need this for study
How i do ? Please tell me
amazing! thanks a lot!
very clear explanation
Thankyou Doctor, is very clear and helpfull.
Superb... well explained.
Excellent video! Thank you!
Excellent video sir ; thanks a lot !
What a legend!
Thank you for your explanation! It help me so much to understand my situation. But I just have a question, how long to recover after an ulnar nerve surgery at the wrist ( the 4th and 5th can extend like normal)?
Hope you reply me soon. Thank you!
Hi Hoang pham have you received reply about your hand situation?
Thank you❤
Great vedio s ..you’re the best
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?
God bless you
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.
Very Helpful
Extraordinary.
What was the solution for me
thank you so much it was great as always
Best lecture 👍
you were very helpful
Thankyou Love from Pakistan
what is the treatment ?
i am suffering from it what to do now?
Go see a CHT (Certified Hand Therapist). They could be occupational or physical therapists. They will evaluate you and see if it is ligament shortness, tendon rupture, inflammation, or nerve palsy from an acute or chronic injury and know best how to help. Potentially, they will refer you to a surgeon, if necessary. Just saving you an MD visit (depending on the state).
@Barry White Sorry to hear that you're going through such a struggle. If it's been 20+ years the chance for recovery may be minimal to absent. To complicate things further, ulnar nerve repairs have a worse outcomes than median or radial nerve repairs. An anti-claw splint may be useful for positioning the joints for functional use, unless that is, your joints are contracted. Good luck, hope you find some relief.
@Barry White so you never regained any hand muscle? Did you have a compression at the elbow level?
@Barry White Did you have a severe compression? did you require a AIN nerve transfer? are your intrinsic muscles working? did you loose all the muscle that the Ulnar innervates? i am doing therapy and four weeks now nothing regained for me :(
@Barry White i definitely will try the Turmeric remedies and hand Therapy. What i had first was a compression at the elbow which was decompressed then because it was proximal the Ain nerve had to be grafted to the Ulnar nerve motor component in the Forearm soi nerve axons get to the Hand,it only keeps the Ulnar Muscles alive it won't regain function so when the native nerve recovers then you may regain function
Very helpful 👍
Thank you!
Thank u it was really help full
Simple and easy👍
Thank you.
i came here for a solution... looks like i have to go see a doc
Dr. Bhi chutiya bana raha bhai mera
Thank you sir.
Thanks your are veryyy helpful
I had a test done on both hands recently, left hand showed ulnar nerve was slow to respond in my left hand, I suffer from constant numbness throughout the day, and am woken out of a dead sleep every night due to my left hand almost totally numb, I've tried braces, both just from the elbow to the wrist, and also the brace..thats impossible to sleep with, preventing the elbow bending at night, neither one worked, and now I am starting to drop stuff, I refuse to use any of my glasses, or anything that is glass for fear of dropping it, I'd like the surgery to move the nerve but my dr keeps telling me to use braces...I'm getting upset at his one track mind and not willing to think outside the box, I'm scared I'm gonna end up with claw hand if this isn't fixed
You will need to see a Neurologist
@@gz2809 I have same problem of claw hand let me explain in detail
I think when I was in 5 standard i had an injury in wirst on left hand after some time injury had recovered after some time I was lossing sensetion .My parents started treatment doctor was giving medicine but i was not getting recovery so I canged doctor other doctors said you have to take nerve testing after that doctor said you need Sergey on elow because your nerve in pressed below elow so we will take nerve upward. I was in 7 standard that time ,I got Sergey on Elbow tho i didn't recovery and doctor was giving medicine now I am 23 year old having fear that it is increasing I am looking for solution now ..
Please Acknowledge me @GZ2
@@aquafarmer3481 Basically after all this time you are saying this starred when you were 5;years Old? If this is the Case then only a Tendon Transfer will give back some function.
Same for me my doctors nor work comp understand
Very very helpful😁
Fantastic. JAZAKALLAH brother for this very helpful video. 👏👏👏
Sooooo 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...
Thanks sir🙏🏻 useful.
What to do If someone is suffering form ulnar claw hands Dr. Nabil
Simple Rules hy
same problem
do it.... 6:30
Hello to all I will shed some light on this topic.
Firstly Dr Nabil will never answer in the comments so the questions towards him will never be answered by him.
Secondly he is not always right and I can prove it then I will tell you my condition.
He says the claw hand results from a lower lesion more often meaning the ulnar nerve is entrapped or damaged at the wrist and this is false as I had a ulnar nerve entrapment at the elbow and within weeks I deteriorated, claw hand muscle wasting and all so I have a high level lesion and have the clawing of the fourth and fifth fingers.
Now I will explain what the solution is to this. Basically if you have a claw hand your ulnar nerve has suffered major damage and the clawing will not go away with any therapy at all.
The lesion must be identified where then surgically decompressd or nerve graft or nerve repair must be performed.
I had a decompression at the elbow but due to the extent of the damage done by the entrapment my nerve died and as a result I have a claw hand. If anyone had a cut ulnar nerve and was repaired then they would have been told that the nerves regenerate at 1mm a day and must grow into the muscle again to start working.
Sadly the muscle has already atrophied so it only is viable for around 18-24 month's then it is no longer useful.
For anyone who is entrapped or had their nerve cut at the elbow there is a operation called the AIN nerve transfer this is where a small nerve is grafted to the side of the ulnar nerve and it's suppose to start sending nerve axons to the hand but this process is by no means quick, I have been exactly 6 months since my surgey and still have no effect from the nerve transfer.
The nerve transfer also is only to keep the motor end plates alive until the native axons regenerate from where they were damaged.
I'm not a Dr but I am telling you from my experience and having seen many Drs that this is a very long recovery and it is never full complete.
It is a peripheral nerve injury and a very serious peripheral nerve injury due to this function that is a result.
Anyone who has this I urge them to seek their Drs out and get the appropriate tests to confirm where the ulnar nerve lesion is.
This surgey can be performed by a
Neurosurgen
Plastic surgeon
Hand surgeon
Make sure they have experience with nerves as this is a very delicate process. Any questions please feel free to to ask me.
@@ildikotuzes6183 you should make a Video of your experience and post it. It will be helpful..
Sir but my middle finger and the index finger has problem in straightening too.. Though there is less pain compare to ring finger n small finger... Whenever if I have to open my fingers firstly it's small finger then ring finger, then middle n lastly the index... But the acute nerve pain is only on my ring finger... This is all the matter of my right hand... Sir please help me.. Its been years after my accident in the year 2000...i shall be obliged if you will let me know about it n its treatment..
Please upload musculoskeletal conditions
Thanku so muchhh sirrr🙏🏻🙏🏻
Good please ,you are mazing I always see your videos
Congratulations
Please tell me the treatment ???last 2 fingers
Thank you x
Recovery from this like any physiotherapy exercise or treatment options
Nabeel ebrahim inshaallah waiting for your respond
Thanks alot
Thanks for your help and
Both right and left hand will be effect at a time
My 4th 5th fingers are have no sense and muscle loss also occurred ne
How are you doing now? Are you cured?
Same thing happend to my father in law and the doctors suspected MND.
Bro are you cured now? i am going through the exactly same condition can you please tell me solution for this ? My plaster (pop cast) was so tight that it damaged my muscles also and i am facing overall muscle loss too on hand please reply bro as soon as possible
Thanks you
Treatment waries according to duration....age....associated pathologies.....and severity at presentation
there are different type of treatments...
Are you a real doctor?
Thnx a lot
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
please explain with medicine.
What is the treatment?
No treatment for this.
The Treatment is, relive the compression on the ulnar nerve as that what causes this. Why do you say no treatment how do you know?
Dr.punjab salarpura ,up
Kya problem hai apko
@@sadiquezaman1141 what does that mean
Cures?
Healing?
Remedies?
Time only?
how can i cure from this problem? plz help me.. what is its solution?
Kno help paisen vai
you can try seeing a doctor
Please tell us some tips for this Hirayama Disease
Have you find any treatment for that till now?
Helpful
What is a solution this problem
I call it “Naruto hand”
Lovely Video clip! Sorry for chiming in, I am interested in your opinion. Have you heard about - Taparton Sturdy Nerves Takeover (should be on google have a look)? It is a great one off guide for Getting rid of Neuropathy minus the headache. Ive heard some awesome things about it and my friend at last got astronomical success with it.
Its not joke For god sake its serious shit
Well i have it
@@iaviic9479 Very Serious!
Far from Funny
Thanks sir
Hi sir, May I know some exercises for ulnar never
Thnx dr Ibrahim
Flexor digitorum profundus flexes the mcp joint,, then why there is no opposition to extensor digitorum
Just had my surgery to fix this and have been using this clip to inform everyone who asks about my surgery.
How was the surgery?
Andy Pritchett very good. I had immediate results in my elbow. My hand will take awhile as I have had this for years. I’m 30
@@Louielou187 did you loose any of the hand muscles?
Andy Pritchett surgery went well! To full results it’ll take nearly a 5-6months. Right now it just won’t get worse which is great. Nerves grow back very slow
Ildiko Tuzes yes I did. I had cubital tunnel syndrome for about 4 years
I got this problem recently did have surgery transpositioned the ulnar nerve coz it's stucked between the to two bones in elbow any chance to get back to normal I lost the muscles of my hand as well what should I do ?
Thanks!
Same here I'm fighting it mine came from left arm in chopsaw at work jobless now can't even pay my bills
Hello there. I’ve been referred to the transposition surgery as well. Same problem coming from the elbow and muscles in my hand are almost all gone (still have some). How’s your situation now after surgery?
I'm gonna have to stop whining about my dupuytrens contraction after watching this..