In a patient with high median nerve injury at the elbow level (e.g., after a supracondylar fracture), the classic deformity of the hand includes inability to flex the index and middle fingers at the DIP joints, with flexion preserved at ring and little fingers. This deformity is called:

• A Ulnar claw hand
• B Wrist drop
• C Ape (simian) hand deformity with benediction sign on attempted fist closure ✓
• D Intrinsic minus hand

Explanation

High median nerve palsy results in paralysis of the FDP to the index and middle fingers (supplied by the anterior interosseous nerve, a branch of the median nerve), FDS to all fingers, and the thenar muscles. On attempting to make a fist, the index and middle fingers remain extended (unable to flex at DIP because FDP is paralysed) while the ring and little (supplied by ulnar FDP) do flex, creating the 'benediction sign' (or 'pointing index'). The overall hand also develops an 'ape hand' — flattening of the thenar eminence with the thumb adducted and unable to oppose — because the thenar muscles (APB, opponens, FPB superficial head) are all paralysed. This is distinct from ulnar claw (ring-little finger clawing from intrinsic minus of ulnar-innervated lumbricals).

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.