User:Exphysdtr

Prevention of Ulnar Nerve Entrapment (Ulnar Claw)

Ulnar Claw
Ulnar claw (also known as ulnar nerve entrapment, or claw hand) is an abnormal hand position that is caused by problems with the ulnar nerve in the forearm. An ulnar claw hand will have the 4th and 5th fingers flexed at the first knuckles and curled towards the palm at the 2nd and 3rd knuckles. The hand will display “hyper-extension of the metacarpophalangeal joints (MCP) and flexion at the distal and proximal interphalangeal (IP) joints of the 4th and 5th digits (ring and little finger) (Neiman, 683).” The clawing will become most apparent when the patient is asked to straighten their fingers. Patients with ulnar claw are also frequently unable to spread (abduct) or pull together (adduct) the fingers against resistance (Nasim 118). This occurs because the ulnar nerve also innervates the palmar and dorsal interossei of the hand. Patients with this problem will become “increasingly easy to identify over time as the paralyzed first dorsal interosseous muscle atrophies, leaving a prominent hollowing between the thumb and forefinger (Wheeless)”. An ulnar claw may occur after an ulnar nerve lesion which results in the partial or complete denervation of the medial two lumbricals of the hand . Since the lumbricals normally flex the MCP joints, “their denervation causes these joints to become extended by the newly unopposed action of the extensor muscles of the forearm (extensor digitorum and the extensor digiti minimi).” The lumbricals also extend the fingers at the interphalangeal (IP) joints. Their paralysis results in an unopposed flexion from the flexor digitorum profundus at the IP joints. The combination of hyperextension at the MCP and flexion at the IP joints gives the hand its claw like appearance (Wheeless).

Prevention
Prevention of the ulnar claw includes exercise, stretching, proper bodily function, and myofascial release.

Exercises
Exercises must be focused on the forearm muscles including the extensor carpi ulnaris and the extensor digitorum in order to antagonize the flexion of the fingers. They include the rubber band spread and the hand extension.

Stretching
Stretching the muscles around the ulnar nerve includes stretching the flexor carpi ulnaris, and the flexor digitorum profundus. This releases the tightness that may interfere with the innervations of the ulnar nerve. Proper bodily functions include avoiding repetitive and strenuous activities with the hands, such as those conducted by landscapers, heavy duty mechanics, carpenters, and industrial insulators .” Constant gripping of heavy machinery and tools are a culprit for excessive finger flexion.

Myofascial Release
Myofascial release at the forearm muscles include massaging or foam rolling. This alleviates the tightness, or muscle adhesion, that occurs with the over-exertion of muscle tissue.