Median and Ulnar Nerve Injuries HELP

[FutureDoc4]

Okay, I think First Aid treats this EXTREMELY badly. I need some clarification on this (especially if Pope's benediction--injury to ulnar nerve is seen in both proximal and distal ulnar injuries).

Please take a look at the attached and note any problems or inaccuracies. I NEED to get this cleared up and I find it unbelievable there is NO straight forward resources out there on this.

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[usmletoo]

-normal function: Flex MCP, extend IP (P and D)
-innervation:
Median: 2nd-3rd digit
Ulnar: 4th -5th digit

Claw hand - lesion ulnar
when asked to make a fist the patient:
ok 2nd and 3rd =median
not working 4th and 5th : there is hyperextension of MCP and flexion of IP instead of normal function: Flex MCP, extend IP (P and D)

Pope's blessing: lesion median nerve the patient:
when asked to make a fist
OK 4th and 5th=ulnar
not working 2nd and 3rd: there is hyperextension of MCP and flexion of IP
instead of normal function: Flex MCP, extend IP (P and D)

complete claw: lower trunk
when asked to make a fist the patient:
all fingers are affected
there is hyperextension of MCP and flexion of IP

(I believe it is like this)

 

[ChiDO]

Here is a quick rundown:

Proximal Median Nerve: Lose 2L-OAF muscles --> "Ape Hand"

Distal Median Nerve: Lose 2L --> Thus, when you say "Extend your fingers", pt can't, so you get "Clan of 2nd/3rd digit." Next you say, flex your wrist, you get "Ulnar deviation"

Proximal Ulnar Lesion: Flex wrist --> radial deviation. "Straighten Fingers" --> Pope's blessing

Distal Ulnar Lesion: "Straighten Fingers" --> Pope's blessing (4th/5th flexed).

Hope that helps. I think that's right, but someone correct me if I'm wrong.

 

[usmletoo]

http://en.wikipedia.org/wiki/Ulnar_claw
http://en.wikipedia.org/wiki/Hand_of_benediction

 

[rem6775]

Honestly, the best way to remember this is to complete forget about the naming system people use for it. It is completely and utterly stupid. I'm sorry, but you can't call multiple things "claw hand" and expect to create no confusion. Or name things differently based on whether you asked people to make a fist or extend the fingers. Forget it all, it's stupid.

Instead, just look at what the muscles do and what they are innervated by. You can figure out a good portion of the lesions based on lumbrical action only. They flex MCPs and extend PIP/DIPs. So it's pretty easy to distinguish ulnar v. median nerve lesions strictly on this group's action. Do lumbricals on digits 2/3 work and 4/5 not? Ulnar lesion. Do 4/5 work but not 2/3? Median. Then if you want to see if its a distal lesion, does the wrist deviate on flexion, or is their atrophy of the eminences? It's really very simple, but the whole naming scheme confuses everything.

 

[FutureDoc4]

Some of the intuitive stuff makes sense... but some people are saying distal lesions cause the change in wrist flexion.... how does that work? I would guess the more proximal lesions would affect flexion at the wrist(like affecting the flexor carpi radialis)... def a point of confusion... Honestly, I felt like i could intuitively do this... until I looked at First Aid.... that it got all confabulated.