Claw hand occurs as a result of ulnar nerve palsy. Depending on the underlying cause of the condition, other symptoms may also occur. Treatment of claw hand is possible and promising in many cases.
What is claw hand?
Claw hand is a disorder of the hand that is manifested by loss of function in the bones. The hand can no longer be moved normally and affected individuals have a splayed thumb that cannot be bent. The base joint of the fingers is also damaged, resulting in the typical alignment of the fingers that resembles a claw. In connection with a claw or claw hand, numbness often occurs in the little finger and the ball of the little finger. The unnatural posture of the hand leads to further discomfort and massive limitations in everyday life.
Causes
Claw hand is the cause of ulnar nerve palsy. This can have various causes. It is often due to external force on the upper arm. Fractures, injuries, or surgical procedures can also cause ulnar nerve palsy and thus claw hand. In addition, claw hand occurs when the ulnar nerve is exposed to long-term pressure. This is the case, for example, when the elbow is used for support. This can lead to paralysis in the long term and later to the development of a claw hand. People who regularly engage in cycling are also at risk, as the ulnar nerve is also heavily stressed here. So are bedridden people who put excessive strain on the nerve, and patients who have had surgery on the relevant part of the body without sufficient padding. Generally, then, the causes are due to damage to the ulnar nerve. It is also called ulnar groove syndrome. Tumors or cysts that become lodged in the ulnar nerve area may also be the cause.
Symptoms, complaints, and signs
A claw hand can be recognized primarily by the deformity of the fingers that gives it its name. Affected individuals notice that the base joints of the fingers are hyperextended and the end joints are slightly bent. The claw hand is particularly obvious on the ring finger and the little finger. In most cases, it is no longer possible to spread or squeeze the fingers together. The deformity causes further symptoms such as pain, numbness and cramps in the hand. In addition, disturbances in sensitivity can occur. If the anomaly occurs in connection with an injury to the hand, swelling, bleeding and other external signs may also be added to the symptoms and discomfort mentioned above. A clawed hand often becomes noticeable only after months or even years, as the symptoms develop insidiously. In most cases, permanent damage has already developed, for example nerve disorders or joint wear due to the constant malpositioning of the fingers. Furthermore, circulatory disorders may occur and scars may remain. If the claw hand is treated early, late consequences are unlikely. The postural anomaly quickly recedes after surgery or drug treatment and only mild pain and feelings of tension remain, which also recede after a few weeks.
Diagnosis and course
The suspicion of a claw hand can usually be expressed by the affected person himself. Thus, the malposition of the hand clearly indicates that damage is present. Numbness in the fingers is also a first indication. The doctor can confirm the suspicion in a comprehensive discussion with the affected person. For this purpose, the medical history is reviewed, and the physician also asks about the patient’s daily occupational routine. After taking a medical history, a neurological examination is performed. Various functional tests are used to test ulnar function and verify whether ulnar palsy is present. One of the tests concerns, for example, the ability of the hand and fingers to bend. This is followed by a test called electromyography. This measures the nerve conduction velocity, which in turn provides information about paralysis. Once the claw hand has been clearly diagnosed, the exact cause still needs to be determined. Ulnar nerve palsy is often the trigger, but other nerve diseases can also be responsible for the complaints. A claw hand develops slowly and is usually recognized too late by those affected.However, if action is taken early, regression of the paralysis can be achieved. If the disease is too far advanced, the only option is to alleviate the symptoms. Claw hand is not fatal, but it does result in far-reaching limitations in everyday life for those affected.
Complications
In claw hand, there are severe limitations in the movement and function of the hand. In this case, the affected person can no longer move the fingers properly and is not infrequently dependent on the help of other people in everyday life. Especially in children, claw hand can lead to considerable difficulties and significantly reduce the quality of life. As a result, the child’s development can also be disturbed and delayed. Furthermore, those affected suffer from a severe malpositioning of the fingers, resulting in pain. Not infrequently, the hand is swollen. The hand and fingers suffer from numbness or are completely paralyzed. The typical tingling sensation and other unpleasant sensory disturbances occur. In the worst case, the paralysis is irreversible and cannot be cured. Treatment of claw hand is usually always causal and depends on the underlying disease causing the complaint. In many cases, however, surgical intervention is necessary to treat claw hand. However, no particular complications occur. Those affected must also continue to take care of the hand and not subject it to heavy loads.
When should one go to the doctor?
If numbness in the hand is noticed, the family doctor should be consulted. Other symptoms, such as a loss of function of the fingers or the typical malposition of the hand, also require clarification. The help of a doctor is necessary if the signs of a disease persist for days or weeks and affect the quality of life. If further symptoms appear, a doctor must be consulted on the same day. A doctor must be consulted immediately after an accident or fall, especially if claw hand symptoms are accompanied by pain or injury. Individuals who cycle regularly, have had hand surgery, or are bedridden are especially likely to develop claw hand. Anyone who is part of these risk groups must always consult their family doctor or a sports physician with physical complaints. At the latest when unusual dysfunctions or chronic pain develop, the claw hand must be diagnosed and given medical attention. Those affected should see the general practitioner or a specialist. With children, it is best to go to the pediatrician. During the treatment of a claw hand, close monitoring by the physician is necessary. The patient should visit the medical doctor regularly and inform about the mobility of the hand and any complaints.
Treatment and therapy
Claw hand must be treated quite individually. Therapy depends on the causes of ulnar nerve palsy, the circumstances and the individual symptoms of the affected person. Generally, both conservative and surgical procedures are used to treat claw hand. If it was caused by a pressure load, it is often possible to resolve the symptoms by resting the affected arm alone. A splint can also be used for this purpose. If the non-surgical treatment does not work, a surgical intervention can help. Depending on the situation, the doctor decides whether the paralysis can be remedied by surgery. The decisive factor is whether it is possible to relocate the ulnar nerve. Removal of scar tissue can also give the nerve more space and thus remedy the claw hand. Following the procedure, the patient usually must rest for several weeks.
Outlook and prognosis
With early conservative therapy, there is a chance that the claw hand will regress. Surgical intervention may reduce pain. However, motor or sensory deficits usually cannot be completely resolved. In the long term, ulnar nerve palsy may fuse with surrounding tissue. The prospect of recovery is then rather poor, as further movement restrictions occur. If the patient complies with the doctor’s instructions and continues to adhere to physiotherapy and sparing, a claw hand can continue to be used to perform everyday tasks for many years.A prerequisite for a good prognosis is permanent sparing of the affected hand. The patient must not use the claw hand for support and must avoid frequent bending and stretching movements. However, the pain must always be treated with prescription pain medication. If no treatment is given, the symptoms of pressure palsy increase in intensity. After only a few months, the deformity can become so severe that recovery is no longer possible. The patient is then permanently dependent on aids such as crutches. The restrictions represent a considerable cut in the quality of life. Life expectancy is not reduced by ulnar nerve palsy. However, physical and mental sequelae can develop that impair well-being. Nerve damage and circulatory problems may occur over the course of a lifetime.
Prevention
A claw hand can be well prevented. It is already sufficient to pad the arm well during appropriate work or activities to minimize the risk. Cyclists can put on appropriate padding to prevent a claw hand. In general, it helps to take it easy on the area around the elbow and to consult a doctor directly at the first warning signs. If a direct reaction is taken when a tingling sensation in the fingers and a slight flexion occur, serious consequences can be prevented. A claw hand that occurs as a result of a fracture or injury is difficult to prevent. Diseases such as tumors, inflamed tissue, or cysts that pinch off the ulnar nerve also cannot always be prevented.
Follow-up
In the case of a claw hand, there are usually only a few measures of aftercare available to the patient. As a rule, a diagnosis should be made very early in this disease to prevent further complications and to prevent the symptoms from continuing to worsen. In the case of the claw hand it can also not come to an independent healing, so that always a treatment by a doctor must take place. An early diagnosis always has a positive effect on the further course of the disease. In most cases, a surgical intervention is necessary, which can significantly alleviate the symptoms. After such an operation, bed rest is necessary. The patient should rest and continue to take care of his body. No strenuous or physical exertion or activities should be performed. In particular, the affected hand should not be strained. Many patients are restricted in their everyday life due to the claw hand and need the help of family members and other relatives. In most cases, physiotherapy measures are also necessary, although those affected can also repeat many of the exercises in their own homes. Claw hand usually does not reduce the life expectancy of the affected person.
What you can do yourself
A claw hand requires individualized treatment by a doctor. If the condition is mild, medical therapy can be supported by rest and targeted stretching and loosening exercises. If the complaints are based on a pressure load, these measures are usually already sufficient to remedy the claw hand. The cause of the severe stress on the fingers must be determined and corrected in order to achieve a long-term improvement. In the case of a pronounced claw hand, surgery is usually necessary in which the ulnar nerve is relocated or scar tissue is removed. Affected individuals should schedule surgery early before further complications develop. After surgery, the patient must take it easy for several weeks. Depending on the cause, various measures such as relaxation exercises or stretching can promote recovery. Cyclists who suffer from claw hand should think about changing their sport. Especially after a surgical intervention, renewed stress on the finger bones can have serious consequences and may even cause permanent damage. If the cause is unknown, the affected person should arrange for further examinations. It is possible that the condition is caused by a cyst or tumor that needs to be removed.
