<prompt> Total claw hand is seen in the paralysis of: September 2005Ulnar and median nerveUlnar nerveMedian nerveRadial nerve  <response>: Ans. A: Ulnar and median nerve Claw hand deformity is manifested by flattening of the transverse metacarpal arch and longitudinal arches, with hyperextension of MCP joints and flexion of the PIP and DIP joints; This deformity is produced by imbalance of the intrinsic extrinsics: i. Intrinsic muscles must be markedly weakened or paralyzed to produce claw deformity; Long extensor muscles hyperextend the MCP joint, long flexor muscles flex the PIP and DIP joints; weakness of the long flexors as in high palsy actually decreases claw fingers; In ulnar nerve palsy, only the medial two fingers develops clawing while all the four fingers develop clawing in combined median and ulnar nerve palsy. 