Hansen’s Disease-induced Hand Deformity: Claw Hand

• Claw hand is the most common deformity in leprosy:
  • It is due to paralysis of the intrinsic muscles hand which is innervated by the median and/or ulnar nerves.
  • Leads to hyperextension of MCP (metacarophalangeal) joints and flexion of the IP (interphalangeal) joints.
• Management consists of occupational therapy and/or reconstruction surgery.
• In this case report from Indonesia the authors report a 32 year old male with hyperesthetic red plaques and punched out lesions on the arms and legs
  • Once diagnosed, he was treated with MDT (multi-drug treatment) and reeducation
  • Reeducation consists of:
    • sensory reeducation: introducing hands into objects (circle, square), texture (rough, smooth) and handling of other known objects
    • occupational therapy (manipulating objects)

    Result was subjective improvement reported by the patient on day 29: “decrease in stiffness and movement difficulty 2nd finger left hand and 5th finger right hand”.

Conclusion: although reeducation is possible, prevention is better and this consists of treating Hansen’s at its early stages.

Contributors

Dr Christophe Hsu – dermatologist. Geneva, Switzerland

Source of Information: Yuwita W – Claw Hand in Mild Borderline Leprosy Treated with Sensory Re-education. 2014 (4) – 21st Regional Conference of Dermatology; Danang (Vietnam)