Reconstructive surgical correction of ulnar nerve paralytic claw fingers in Hansen's disease patients by Lasso procedure

The two extremes of Hansen’s disease—Different manifestations of leprosy and their biological consequences in an Avar Age (late 7th century CE) osteoarchaeological series of the Duna-Tisza Interfluve (Kiskundorozsma–Daruhalom-dűlő II, Hungary)

“…Leprous dysfunction of the motor peripheral nerves innervating the hands and feet, that occurs in more advanced stages of Hansen’s disease, leads to progressive paralysis of individual muscles and muscle groups with secondary deformation and disfigurement of the affected limb(s) [ 50 , 54 , 75 – 78 ]. For instance, loss of motor function in the ulnar and posterior tibial nerves can result in the development of ‘claw-hand’ or ‘flat-foot’ deformity, respectively.…”

“…In the middle-aged male, the shallow grooves were present across the entire width of the palmar surface of the affected left and right proximal phalanges, implying that there was no lateral deviation in his involved proximal interphalangeal joints [ 50 ]. Claw-hand deformity, secondary to motor impairment in the ulnar nerve, is usually more evident in the 4 th and 5 th fingers (partial claw-hand) but the 1 st , 2 nd , and 3 rd fingers can also become clawed (complete claw-hand) [ 77 , 78 ]. The presence of marginal osteophytes on both sides of the proximal and middle phalangeal diaphyses of KD271 could refer to permanent contracture of the soft tissues in both of his hands, since these alterations were described as entheseal changes of the superficial finger flexor muscles [ 79 , 80 ].…”

“…In the middle-aged male, deformation could have led to disfigurement of the hands and deterioration of the hand functions (e.g., weakened grasp, grip, and pinch) [ 81 ]. Thus, he would have experienced disability in performing the basic activities of daily living [ 78 , 82 ]. It is important to bear in mind that claw-hand deformity can either be congenital or acquired–it can be caused by injuries or disorders that lead to neuropathy of the ulnar nerve (e.g., Charcot-Marie-Tooth disease, burn injury to the hand or Hansen’s disease) [ 78 , 83 , 84 ].…”

“…Thus, he would have experienced disability in performing the basic activities of daily living [ 78 , 82 ]. It is important to bear in mind that claw-hand deformity can either be congenital or acquired–it can be caused by injuries or disorders that lead to neuropathy of the ulnar nerve (e.g., Charcot-Marie-Tooth disease, burn injury to the hand or Hansen’s disease) [ 78 , 83 , 84 ]. Therefore, the presence of claw-hand deformity cannot be considered as a pathognomonic feature of leprosy [ 54 ].…”

Reconstructive Surgery of Ulnar Claw Hand in Leprosy Patients by Lasso Procedure

“…In indirect Lasso, a different muscle like Palmaris Longus, Extensor Carpi radialis longus, brachioradialis is used. 22,23,24 The direct lasso procedure was used in all our cases, and the procedure is described under surgical technique. The chances of deformity are more in the little finger because the muscle bulk and power are weaker in the little finger so while reconstruction the split FDS tendon was fixed with more tension on the small finger.…”