Correction of paralytic hand deformities

Abstract

The ulnar nerve is most commonly involved in leprosy and is affected at or just above the elbow. The outcome of this damage is paralysis of the intrinsic muscles of the hand with the exception of the thenar group, together with paresis of ring and little finger flexor digitorum profundus (FDP). Although the obvious deformity is clawing of the fingers, other deformities are produced: 1. Hollowing of the intermetacarpal and thumb web space. 2. Flattening of the ulnar half of the hand. 3. Loss of abduction and adduction of the fingers. 4. Instability of metacarpophalangeal joint(MCPJ) 5. Flattening of the distal transverse metacarpal arch. The overall effect is poor grip due unstable MCPJ, poor grasp because of inadequate opening of the hand, rolling of finger tips and a poor pinch due unstable MCPJ of the index finger. Loss of function and anatomical defects needs surgical correction .The appearance of the hand is also very important for leprosy patients, because it is the characteristic deformity which is the principal cause of social rejection. For every single deformity, there is an operative answer. But performing such a large number of operations defeats the very purpose for which these are performed. The goal should be to achieve the best for functional and social needs of the patients with the fewest interventions. The choice for surgery involves a consideration of disease status, condition of the hand, age, extent of paralysis, occupational needs and also the socio-economic background.