Hand in claw
The claw hand is a condition that causes curved or bent fingers.This gives the appearance of the claw of an animal.
Considerations
A person can be born with hand in claw (congenital) or can develop it as a result of certain disorders, such as an injury in a nerve.
Causes
Causes may include:
- congenital anomaly
- nerve damage in the arm
- healing after a serious burn of the hand or forearm
When to contact a medical professional
If the condition is congenital, it is generally diagnosed at the time of birth.If you notice that this problem is developing, check with the doctor.
What you can expect in the Medical Office
Your care provider will examine and carefully observe your hands and feet.Likewise, you will ask questions about your clinical history and symptoms.
You can do the following exams to see if there is nerve damage:
- Electromyography (EMG)
- Nervous driving studies
Treatment
Treatment depends on the cause.This may include:
- Use of splints
- Surgery to repair problems that may be contributing to the hand in claw, such as problems with nerves, anomalies in tendons, joint contractures or cicatricial tissue
- Therapy to stretch your fingers
Ischemic Contracture of Volkmann
Volkmann's contracture occurs when there is a lack of blood flow (ischemia) to the forearm. This is usually presented when there is increased pressure due to a swelling, a condition called a compartment syndrome.
An arm injury, even by crushing or fracture, can lead to a swelling that compresses the blood vessels and can reduce blood flow to the arm. A prolonged decrease in the blood flow causes damage to the nerves and muscles, making them shorten and become rigid (healing).
When the muscle is shortened, pulling the joint at the end of the muscle, exactly as would if it normally contains, but because said muscle is rigid, the joint remains bent and locked. This condition is called contracture.
In the contracture of Volkmann, the forearm muscles are seriously injured. This leads to deformities by contractures on the fingers of the hand, the hand and the wrist.
There are three levels of gravity in the contracture of Volkmann:
- Mild: Contracture of two or three fingers only without or with little loss of sensitivity.
- Moderate: All fingers are bent (flexed) and thumb sticks to the palm of the hand;The wrist can be stuck and blocked and there is usually some loss of sensitivity in hand.
- Severe: All muscles on the forearm that flex and extend the wrist and fingers are committed.It is a highly disabled condition.
The injury that usually causes this condition is an elbow fracture in children.Other conditions that can cause an increase in the pressure on the forearm are, among others:
- Animal bites
- Any fracture of the forearm
- Hemorrhagic Disorders
- Burns
- Excessive exercise
- Injection of certain medications on the forearm
Symptoms
The main symptom is the pain that does not improve with rest or analgesics and that remains worse over time.If the pressure continues, there will be:
- Decrease in sensitivity
- Paless of the skin
- weakness
Tests and exams
The doctor will carry out a physical examination. If you suffer from the compartment syndrome on your forearm, you will experience intense pain when the doctor moves the fingers from hand up and down. It is possible that the forearm is very swollen and bright. Likewise, you will feel pain when you squeeze your forearm.
The diagnosis can be confirmed with an exam that directly measures the pressure in the area, which involves introducing a needle into the affected area. The needle is stuck to a pressure gauge. There is a specific level of pressure that confirms the diagnosis of the compartment syndrome.
Treatment
If there is a fracture on the forearm or elbow, you must use a sling or splint to keep the area immobilized and raise your arm over the heart level. This helps prevent greater injury and excessive inflammation.
The best treatment is early surgery to release the pressure on the forearm before any permanent injury is presented in the muscles and nerves. Surgery to lengthen and sometimes transfer the muscles is necessary to try to recover some functionality in hand. However, surgery is not as effective as diagnosis and early treatment.
Expectations (prognosis)
The prognosis of a person depends on the severity and stage of the disease at the time the treatment begins.
If surgery to alleviate the pressure is done before permanent damage is presented, the clinical outcome is generally excellent. If there is high pressure on the forearm for a prolonged period, permanent damage can occur to muscles and nerves. If a nerve remains compressed for a time greater than 12 to 24 hours, it will usually be damaged permanently.
People with mild muscle contractures that involve only a few fingers are more likely to return to normal operation. People who lose normal functioning all muscles that move hand fingers and doll need greater reconstructive surgery and do not have a full recovery.
Possible complications
The more severe the contracture, the worse will be the operation of the hand and the wrist. In severe cases, the hand may not work at all and one can have a loss of sensitivity in the area.
When to contact a medical professional
Request an appointment with the doctor if he has suffered an injury to the elbow or forearm and presents swelling, numbness and continuous pain that remains worsening.
