The ulnar nerve consistently drives flexion of the middle finger

Soldado, Francisco; Mf, Ghizoni; Ja, Bertelli

doi:10.1177/1753193413505581

Cited by 4 publications

(8 citation statements)

References 3 publications

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“…21e23 Contrary to what has been stated previously, 4,14 neither proximal interphalangeal nor DIP joint flexion in the middle finger were paralyzed or even weak in our patients, which agrees with studies demonstrating that intraoperative electrical stimulation of the ulnar nerve induces full flexion of the middle finger. 24 Hence, in high median nerve injuries, reconstruction of flexion of the middle finger should not be necessary, contrary to some suggestions. 6,11,19 In our series, paralysis of index finger proximal interphalangeal and DIP joint and thumb interphalangeal joint flexion was a uniform finding, as observed by previous investigators.…”

Section: Discussionmentioning

confidence: 93%

Reappraisal of Clinical Deficits Following High Median Nerve Injuries

Bertelli

Soldado

Lehn

et al. 2016

The Journal of Hand Surgery

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Section: Discussionmentioning

confidence: 93%

Reappraisal of Clinical Deficits Following High Median Nerve Injuries

Bertelli

Soldado

Lehn

et al. 2016

The Journal of Hand Surgery

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“…15,16 There are several reports that show that the muscle belly of the FDP to the middle finger has dual innervation from the median and ulnar nerve and together with intertendineous connections, flexion of the middle finger is still possible with a high median nerve injury. 11,12 Also, several reports show that the palmar abduction function of the thumb is still functionally preserved in up to 70% of patients with a low median nerve injury and that opposition transfer was necessary in only 14% of reported cases. 17,18 The anatomical basis for these findings is the deep head innervation of the FPB by the ulnar nerve and‚ in one-third of the cases‚ dual innervation of the superficial head of the FPB.…”

Section: Discussionmentioning

confidence: 99%

High Median Nerve Paralysis: Is the Hand of Benediction or Preacher’s Hand A Correct Sign?

Duraku

Schreuders

Power

et al. 2022

Plastic and Reconstructive Surgery - Global Open

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Background: High median nerve injuries are commonly presented in textbooks as adopting the typical posture of hand of benediction or preacher’s hand. This study aimed to show that the hand of benediction or preacher’s hand is incorrectly associated with a high median nerve paralysis. Methods: A retrospective review of four cases with a high median nerve injury is presented. Diagnosis of a high median nerve injury was performed by means of intraoperative findings, electrodiagnostic studies, or ultrasound imaging. None of the patients presented in this study had a hand of benediction on physical examination despite the presence of a high median nerve lesion. Results: All four patients with high median nerve injuries showed a similar hand posture when attempting to make a fist. Firstly, the index finger still flexed at the metacarpophalangeal joint because of the ulnar innervated interossei muscles. Secondly the thumb is completely abducted at the carpometocarpal joint and extended at the interphalangeal joint. Lastly, middle finger flexion is possible due to dual innervation of its flexor digitorum profundus by the ulnar nerve as well as due to the quadriga phenomenon. Conclusions: The clinical appearance of a high median nerve palsy is different from the classical hand of benediction or preacher’s hand posture pointing finger. We have shown that this incorrect association can result in delayed referral of patients with high median nerve injuries.

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“…Using both anatomic and histological studies, Won et al demonstrated communications branches between the median and ulnar nerve within the belly of the FDP in 26 of their 28 specimens. Clinical evidence of cross innervation of the FDP by the median and ulnar nerve has recently being reported by Soldado et al The FDP of the middle finger is known to be innervated by the median nerve . However, in patients with a high median nerve injury Soldado et al demonstrated that flexion of the distal phalanx of the middle finger is preserved.…”

mentioning

confidence: 96%

“…Clinical evidence of cross innervation of the FDP by the median and ulnar nerve has recently being reported by Soldado et al The FDP of the middle finger is known to be innervated by the median nerve . However, in patients with a high median nerve injury Soldado et al demonstrated that flexion of the distal phalanx of the middle finger is preserved. They also demonstrated that electric stimulation of the ulnar nerve produced flexion of the distal phalanx of the middle finger …”

mentioning

confidence: 96%

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The median nerve consistently drives flexion of the distal phalanx of the ring and little fingers: Interest in finger flexion reconstruction by nerve transfers

2014

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Surgeons believe that in high ulnar nerve lesion distal interphalangeal joint (DIP) flexion of the ring and little finger is abolished. In this article, we present the results of a study on innervation of the flexor digitorum profundus of the ring and little fingers in five patients with high ulnar nerve injury and in 19 patients with a brachial plexus, posterior cord, or radial nerve injury. Patients with ulnar nerve lesion were assessed clinically and during surgery for ulnar nerve repair we confirmed complete lesion of the ulnar nerve in all cases. In the remaining 19 patients, during surgery, either the median nerve (MN) or the anterior interosseous nerve (AIN) was stimulated electrically and DIP flexion of the ring and little fingers evaluated. All patients with high ulnar nerve lesions had active DIP flexion of the ring and little fingers. Strength scored M4 in the ring and M3-M4 in the little finger. Electrical stimulation of either the MN or AIN produced DIP flexion of the ring and little fingers. Contrary to common knowledge, we identified preserved flexion of the distal phalanx of the ring and little fingers in high ulnar nerve lesions. On the basis of these observations, nerve transfers to the AIN may provide flexion of all fingers.

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The ulnar nerve consistently drives flexion of the middle finger

Cited by 4 publications

References 3 publications

Reappraisal of Clinical Deficits Following High Median Nerve Injuries

Reappraisal of Clinical Deficits Following High Median Nerve Injuries

High Median Nerve Paralysis: Is the Hand of Benediction or Preacher’s Hand A Correct Sign?

The median nerve consistently drives flexion of the distal phalanx of the ring and little fingers: Interest in finger flexion reconstruction by nerve transfers

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