Deformities of hand






Wrist drop







  • 1.

    Clinical feature: wrist flexion with/without ulnar or radial deviation.


  • 2.

    Botulinum toxin injection:



    • a.

      Primary target muscles: wrist flexors: palmaris longus (4-4), flexor carpi radialis and/or ulnaris (4-5 & 4-6) depending on deviation (radial or ulnar).


    • b.

      Secondary target muscles: finger flexors: flexor digitorum superficialis & profundus (4-7 & 8), only if finger flexors hypertonia is combined.





Cortical thumb







  • 1.

    Clinical feature: clenched fist but thumb is covered by other four fingers.


  • 2.

    Botulinum toxin injection:



    • a.

      Primary target muscles: thumb opponens (5-2), adductor (5-4), and flexors (4-9 & 5-3, see note) finger flexors: flexor digitourm superficialis & profundus (4-7 & 8).




Note: If thumb interphalangeal joint is not flexed, flexor pollicis longus is not targeted.



Hand intrinsic minus (claw hand)




From Kozin SH, Lightdale-Miric N. Chapter 32 – Spasticity: Cerebral Palsy and Traumatic Brain Injury. In: Wolfe SW, Pederson WC, Kozin SH, Cohen MS, eds. Green’s Operative Hand Surgery. 7 th ed. Elsevier; 2017

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Aug 7, 2021 | Posted by in OTOLARYNGOLOGY | Comments Off on Deformities of hand

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