Dynamic correction of ulnar claw hand deformity with a simple insertion into the lumbrical muscle

Abstract

Numerous methods of tendon transfers are available to correct claw hand deformity. In this article, we describe a simple insertion of the transferred flexor digitorum superficialis tendon, into the lumbrical muscle and proximal tendon. Sixty patients underwent surgery for claw hand correction. These were equally divided into three groups undergoing; modified Stiles Bunnell procedure; 'lasso' insertion into A1 pulley and the lumbrical insertion procedure. Evaluation was done with proximal interphalangeal joint angle measurements, grip strength and using the Brand's criteria, 1 year after surgery. The improvements were comparable among the three groups. Insertion into the lateral bands has been a standard method of claw correction. In addition to correcting the hyperextension of the metacarpophalangeal joint, it transmits force for interphalangeal joint extension and restores the sequence of flexion of fingers, thus making the grasp effective. Insertion into the lumbrical muscle belly and proximal tendon shows similar results. It can be performed via a single incision in the palm, reducing operative time.