The intrinsic minus pattern produces the claw hand deformity of ulnar nerve palsy. With intrinsics paralysed, the EDC (extrinsic extensors) pulls the MCP joint into hyperextension, while the FDS and FDP (extrinsic flexors) flex the IP joints. The paradox: high ulnar lesions (elbow) produce less clawing than low (wrist) lesions because the FDP to ring and little is also paralysed at the high level, reducing the IP flexion force.
Describes the functional consequence of intrinsic paralysis — MCP hyperextension and IP flexion
Intrinsic minus correction in chronic ulnar palsy uses the Brand tendon transfer — the ECRL tendon split into four tails passes volar to the transverse metacarpal ligament and inserts into the lateral bands of fingers 2-5, producing the intrinsic-plus action of MCP flexion and IP extension. The Bouvier test predicts transfer success — if passive MCP flexion restores IP extension, the transfer will work.
Intrinsic minus claw deformity in ulnar palsy corrected by tendon transfer (Brand or Zancolli lasso) to produce MCP flexion and IP extension.
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