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Correction of ulnar claw hand – A comparative study of extensor carpi radialis longus (ECRL) and flexor digitorum superficialis (FDS) as the motor unit of choice


Leprosy is a chronic infectious disease caused by M. leprae, with peripheral neuropathy as its most common manifestation. Deformity of the hand is particularly debilitating and the ulnar claw hand is the most common presentation. There are various surgical options available for correcting clawing in Hansen’s disease. In the present study we have tried to identify patient-related factors favouring either Extensor Carpi Radialis Longus (ECRL) or Flexor Digitorum Superficialis (FDS) as the motor unit of choice.


A comparative study of ECRL (Brand Procedure) and FDS (Stiles–Bunnel) motor tendon transfer in the ulnar claw of hand was carried out. Correction of clawing of fingers was done in 60 ulnar claw hands using transfer of motor units ECRL and FDS. The Z deformity was corrected by 1∕2 FPL to EPL transfer. 12 cases were lost to follow up over the course of 5 years, so 48 cases were followed for up to 2 years, for various activities of daily life and routine work.


Both the transfers gave equivalent results. No morbid deformity was seen in ECRL transfer except the scar on the donor thigh. FDS transfer is the best reconstructive tendon transfer procedure for correction of ulnar claw hand in manual labourers. For white-collar workers, ECRL transfer should be the choice.

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Journal Article
Sajid I
Ahmad S