1/8. Camptodactyly in a neurology outpatient clinic.Camptodactyly is a non-neurogenic flexion deformity of the proximal interphalangeal joint, most commonly affecting the little finger. The frequency of camptodactyly in patients referred to three general neurology outpatient clinics, two in district general hospitals and one in a regional neuroscience centre, over the course of one year (2000) was measured. Five out of 978 consecutive new outpatients (0.5%) had camptodactyly (2 M, 3 F); four had bilateral deformity. In only one was camptodactyly the reason for referral. In two cases, camptodactyly was entirely incidental to the neurological symptoms; in two others it was incidental but might have been confused with the neurological features. In three cases other family members were affected, in a manner consistent with autosomal dominant inheritance with variable penetrance. Camptodactyly is not infrequently observed in the general neurology outpatient clinic. It merits attention in order to avoid confusion with other, neurogenic, causes of clawing, and so avoid unnecessary investigation.- - - - - - - - - - ranking = 1keywords = claw (Clic here for more details about this article) |
2/8. Transient claw hand owing to a bee sting. A report of two cases.We describe two patients with claw hand as a result of a bee sting. It is likely that this was caused by the apamin in the sting which has an effect on the upper limb, at the spinal cord and on the peripheral nerves. It is important to recognise that the claw hand is not owing to compartment syndrome. Both patients were treated conservatively with full resolution within 48 hours, without any lasting effects.- - - - - - - - - - ranking = 6keywords = claw (Clic here for more details about this article) |
3/8. A mucolipidosis III patient presenting characteristic sonographic and magnetic resonance imaging findings of claw hand deformity.Mucolipidosis III (ML-III), or pseudo-Hurler polydystrophy, is an autosomal recessive Hurler-like disorder without mucopolysacchariduria. The diagnosis is challenging for rheumatologists since the musculoskeletal presentation is similar to some rheumatic diseases. We report a case of ML-III in a 16-year-old Taiwanese boy. The characteristic findings of sonography and magnetic resonance imaging (MRI) of claw hand deformity are described. A 16-year-old boy was referred to our rheumatologic clinic because of progressive claw hand deformity, multiple joint stiffness and tightness of the skin over the fingers at the age of 6 years. Sonography and MRI examination disclosed tendon sheath thickening over extensor tendons of both wrists and fingers without features of active inflammation over tendons or joints nor thickening of skin. Urinary glycosaminoglycans were normal. The diagnosis of ML-III was confirmed by the presence of elevated activities of beta-glucuronidase (2141.99 nmol/mg protein/hour), arylsulfatase A (1237.7 nmol/mg protein/hour) and alpha-fucosidase (52.95 nmol/mg protein/hour) in his plasma and decreased activity of these lysosomal enzymes in cultured skin fibroblasts. Sonography and MRI screening for claw hand deformity may offer important clues enabling early diagnosis of ML-III.- - - - - - - - - - ranking = 7keywords = claw (Clic here for more details about this article) |
4/8. A new dynamic lumbrical simulating splint for claw hand deformity.The claw hand deformity, resulting from low ulnar or combined low ulnar and median nerve palsy, is an incapacitating situation. The splint described herein reverses the clawing by substituting for the lumbricals and interossei. If started early, it not only prevents the permanent stiffness of fingers in the claw position, but also effectively restores function without hampering day to day work because it is a surface splint.- - - - - - - - - - ranking = 7keywords = claw (Clic here for more details about this article) |
5/8. Use of a previously repaired tendon for tendon transfer.A patient in whom a previously repaired flexor digitorum superficialis tendon was used for transfer to correct a claw deformity is described. I have found this to be possible under optimal conditions of tendon repair, thus providing the hand surgeon with another choice of donor material.- - - - - - - - - - ranking = 1keywords = claw (Clic here for more details about this article) |
6/8. Clawhand deformity presumed secondary to Parkinson's disease.A clawhand deformity presumed to be secondary to Parkinson's disease is described. No such association was found previously recorded in the literature. The marked limitation in hand function was improved by lengthening the extensor tendons, a 4-tail superficialis transfer to the intrinsic muscles, and capsulotomy of the metacarpophalangeal joints of the index and long fingers.- - - - - - - - - - ranking = 1keywords = claw (Clic here for more details about this article) |
7/8. Sixty cases of partial or total toe transfer for repair of finger losses.Our experience with partial or total toe transfers for the reconstruction of finger deficits is presented. Sixty-one toes were transferred to reconstruct finger deficits in 60 patients. The transfers from the big toe consisted of 3 vascularized whole-nail grafts, 4 onychocutaneous flaps which included the nail and a skin flap from the toetip, 16 thin osteo-onychocutaneous flaps, 4 wrap-around flaps, and 3 combined wrap-around and dorsalis pedis flaps. The transfers from the second toe consisted of 6 trimmed toetips including the nail, 16 second toes, 1 combined second toe and a dorsalis pedis flap, and 1 second toe and third toe. The other transfers mainly consisted of other flaps, including a hemipulp flap and a first web space flap. Regarding the transfers from the big toe, vascularized nail grafts and onychocutaneous flaps were found to be most suitable for the treatment of total nail loss, thin osteo-onychocutaneous flaps for distal phalangeal loss of the thumb, wrap-around flaps with a vascularized iliac bone graft for thumb loss above the metacarpal joint, and the combined wrap-around and dorsalis pedis flaps for a total thumb deficit. Regarding the transfers from the second toe, the trimmed toetips including the nail were most suitable for claw nail deformities, the second toe was most suitable for finger loss except for the thumb with the proximal interphalangeal joint, and the combined second toe and dorsalis pedis flap was most applicable for a total thumb deficit including thenar skin loss.- - - - - - - - - - ranking = 1keywords = claw (Clic here for more details about this article) |
8/8. A new strategy to prevent the sequelae of severe Volkmann's ischemia.This paper compares two treatment strategies in severe Volkmann's ischemia that differ in the time of exploration and excision of the muscle infarct. Six patients underwent late exploration, more than 1.5 months after injury, and 5 patients underwent early exploration, within 3 weeks of injury. Functioning free-muscle transplantation was later performed on all 11 patients for functional restoration. hand function was evaluated in each group to determine the degree of intrinsic muscle function and sensibility. In the late group, all patients had restricted hand function due to clawing, poor opposition, and sensory disturbance. In the early group, all patients had preserved metacarpophalangeal joint flexion and interphalangeal joint extension without clawing, and two had preserved opposition. Sensory disturbance was mild, and good hand function was achieved. In severe Volkmann's ischemia, we advocate early reexploration with excision of the infarcted muscle within 3 weeks of injury or fasciotomy. Early exploration is technically simple, and neurolysis is not necessary. It preserves hand intrinsic function and sensation by removing the ischemic environment and preventing fibrosis that adds to nerve compression and nerve damage.- - - - - - - - - - ranking = 2keywords = claw (Clic here for more details about this article) |