Intrinsic Plus Hand Contracture - Everything You Need To Know - Dr. Nabil Ebraheim
Dr. Ebraheim’s educational animated video describes the condition of Lumbrical Plus Finger in the hand. Contractures of the intrinsic muscles of the fingers disrupt the delicate and complex balance of the intrinsic and extrinsic muscles. Sometimes it is called intrinsic plus hand. The hand assumes a posture with a hyperflexed metacarpophalangeal (MCP) joint and a hyperextended proximal interphalangeal (PIP) joint. Contracted interossei and lumbrical muscles deform the natural cascade of the fingers. Severe disability may result because of weakness in grip and pinch strength. Difficulty in grasping large objects. Causes: •Trauma •Spasticity •Ischemia •Rheumatological disorders •Vascular injury •Compartment syndrome. Bunnell test (Testing the digit for intrinsic muscle or capsular tightness) 1-When the MCP joint is in extension, the intrinsic contracture (interosseous & lumbrical muscle contracture) impedes the flexion of the PIP joint. MCP joint is held extended. 2-When the MCP joint is flexed, the PIP joint flexion increases. Intrinsic tightness treatment: passive stretching, orthotics in mild cases. Surgery is done if the condition is severe or late. Distal intrinsic release of the oblique fibers and preserving the proximal transverse fibers. Options for surgical management are diverse and decided by the cause and severity of contracture. Test for extrinsic tightness •The MCP joint is in flexion •Try to passively flex the PIP joint. The PIP motion less with the MCP joint flexed than when it is extended. (opposite of intrinsic contracture). Treatment is aggressive therapy and tenolysis. PIP joint contracture: the loss of motion of the PIP joint is the same with the MCP joint extended or flexed. Claw hand (intrinsic minus hand): contracture results in intrinsic minus (claw hand) deformity. Condition is usually secondary to crush injury caused by contracture of the intrinsic muscles of the hand. Intrinsic minus: •Flexion of the PIP and DIP joints •Extension of the MCP joint Become a friend on facebook: / drebraheim Follow me on twitter: https://twitter.com/#!/DrEbraheim_UTMC Background music provided as a free download from YouTube Audio Library. Song Title: Every Step
