Disclosures: Jin B. Liu, MD: Nothing to disclose

Case Description: The patient is a 60-year-old undomiciled male who presents with left hand weakness and inability to extend any of his fingers. He reports 2 separate traumas to his posterior elbow about 2 years prior to presentation. Shortly thereafter, he began to experience weakness of his left hand that worsened progressively to the point where he lost functional use of that hand. He also had intermittent numbness and tingling of the entire hand.

Setting: Outpatient Electromyography (EMG) Lab

Patient: The patient is a 60-year-old male who was referred by neurology for EMG study to define his neuropathy.

Assessment/Results: Physical exam revealed a disheveled appearing middle-aged man. Focused musculoskeletal exam of left upper extremity showed complete clawing deformity. Subsequent EMG study localized the severe concomitant median and ulnar neuropathy above the level of the elbow.

Discussion: A complete claw hand is a very rare entity, as it requires concomitant injury of both the median and ulnar nerve proximal to the wrist. Sequelae of such an injury is devastating, resulting in complete functional loss of the hand. Early diagnosis is important since treatment will require surgery and bracing in the acute phase. EMG can localize the lesion for surgical intervention. Prior workup was focused on his wrist. His social situation and possibly undiagnosed psychiatric condition likely contributed to delayed care as well. It behooves clinicians to consider injury proximal to the wrist when presented with a complete claw hand to prevent delays in diagnosis and treatment.

Conclusion: We present a rare case of complete claw hand related to consecutive trauma to the posterior elbow. Subsequent EMG study localized the severe concomitant median and ulnar neuropathy above the level of the elbow. Not only is complete claw hand very rare, it is very difficult to treat. Early electrodiagnostic evaluation can localize the lesion for surgical intervention.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/complete-claw-hand-a-case-report/