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  #1  
Old 03-05-2012
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Default claw hand and pope blessing

this is a very misleading topic since some lumbrical muscle also involved but lets forget about that and simplify
claw hand: ulnar nerve cannot flex 1st and 2nd finger
pope blessing: median nerve cannot flex 3rd and 4th finger

according to kaplan and FA2012 does anyone agree?
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  #2  
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Quote:
Originally Posted by kenlee View Post
this is a very misleading topic since some lumbrical muscle also involved but lets forget about that and simplify
claw hand: ulnar nerve cannot flex 1st and 2nd finger
pope blessing: median nerve cannot flex 3rd and 4th finger

according to kaplan and FA2012 does anyone agree?
i meant ulnar 4th and 5th
median 2nd and 3rd
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Old 03-05-2012
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there's 3 types of claw hand;
1) ulnar claw and 2) median claw.
each is due to damage to its respective nerve, and occurs at rest.
and 3) Klumpke's claw; damage to lower trunk (c8,t1) and also occurs at rest.

there's two ways to get pope's blessing;
1) damage to median nerve; pope's blessing upon attempting to make a fist.
2) damage to ulnar; pope's blessing upon attempting to straighten digits, or at rest (in which it can also be called ulnar claw).

after much confusion and time looking into it, this is what i have established and burned into my memory.

please do tell me if there's any mistake here.
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Quote:
Originally Posted by Dr.NickRiviera View Post
there's 3 types of claw hand;
1) ulnar claw and 2) median claw.
each is due to damage to its respective nerve, and occurs at rest.
and 3) Klumpke's claw; damage to lower trunk (c8,t1) and also occurs at rest.

there's two ways to get pope's blessing;
1) damage to median nerve; pope's blessing upon attempting to make a fist.
2) damage to ulnar; pope's blessing upon attempting to straighten digits, or at rest (in which it can also be called ulnar claw).

after much confusion and time looking into it, this is what i have established and burned into my memory.

please do tell me if there's any mistake here.
yea i agree.
i think the confusion came from flex test and extend test
because both in median and ulnar lesion, both flexion and extension is impaired.
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Old 03-05-2012
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Quote:
Originally Posted by Dr.NickRiviera View Post
there's 3 types of claw hand;
1) ulnar claw and 2) median claw.
each is due to damage to its respective nerve, and occurs at rest.
and 3) Klumpke's claw; damage to lower trunk (c8,t1) and also occurs at rest.

there's two ways to get pope's blessing;
1) damage to median nerve; pope's blessing upon attempting to make a fist.
2) damage to ulnar; pope's blessing upon attempting to straighten digits, or at rest (in which it can also be called ulnar claw).

after much confusion and time looking into it, this is what i have established and burned into my memory.

please do tell me if there's any mistake here.
Ur explanations are correct Dr.NickRiviera. We will get the same picture when damage to both nerves. But I think that the "claw hand" is only used to name the sign of damage to ulnar ( bend 4th 5th digits at rest) and "sign of benediction" is only for the sign of the damage to median nerve (bend 4th 5th only when ask pt to make a fist).
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Old 03-05-2012
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http://www.scrubnotes.com/2008/02/po...claw-hand.html

Read this and clear all doubts.First aid 2011 has error.Gluck
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Originally Posted by step_enhancer View Post
http://www.scrubnotes.com/2008/02/po...claw-hand.html

Read this and clear all doubts.First aid 2011 has error.Gluck

I checked this link. But the guy explains claw hand results due to loss of innervation to interosseous muscles in index and middle fingers😳That can't be. Because Ulnar supplies *all interosseous muscles In hand.

Sorry thats what I thought

Last edited by nadee; 03-05-2012 at 11:03 AM.
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according to Kaplan if we have in proximal median n. injury we have loss of digit flexors(which flex the digit) and also loss of lumbricals 1,2 so that lead to median claw hand which appear digit flexion(due to loss of PIP and DIP extension ) so how is that happen?? Can anyone explain it?
Does clawing happen only in distal n. injury ????
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Old 03-06-2012
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Quote:
Originally Posted by flowerlady View Post
according to Kaplan if we have in proximal median n. injury we have loss of digit flexors(which flex the digit) and also loss of lumbricals 1,2 so that lead to median claw hand which appear digit flexion(due to loss of PIP and DIP extension ) so how is that happen?? Can anyone explain it?
Does clawing happen only in distal n. injury ????
no, clawing happens in both proximal and distal nerve injury

its the things like movement of the entire hand (ie. extension or flexion on one side) that is controlled by muscles of the forearm and therefore these things are not affected by distal injury because u are injuring the nerve past the muscles used for the movement, so those muscles have their innervation intact.
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Quote:
Originally Posted by Dr.NickRiviera View Post
no, clawing happens in both proximal and distal nerve injury

its the things like movement of the entire hand (ie. extension or flexion on one side) that is controlled by muscles of the forearm and therefore these things are not affected by distal injury because u are injuring the nerve past the muscles used for the movement, so those muscles have their innervation intact.

ok that is right but what happenes in proximal nerve injury , as I said before there is paralysis of lumbricals which causes the PIP and DIP to be flexed and also there is as kaplan says paralysis of finger flexors so the 2 counter each other as I understand , which make me confused what is the result????
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Originally Posted by flowerlady View Post
ok that is right but what happenes in proximal nerve injury , as I said before there is paralysis of lumbricals which causes the PIP and DIP to be flexed and also there is as kaplan says paralysis of finger flexors so the 2 counter each other as I understand , which make me confused what is the result????
yep, paralysis of lumbricals
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I know but how both can happen at the same time and they sre counter each other
can anyone explain that
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Any reply?????
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