PMC8607187_01
Clusters of round and polygonal vesicular lesions on erythematous to violaceous base at the right hand (A) and post-intravenous acyclovir treatment (B) along with the ulnar nerve distribution with a claw-like deformity of the right hand.
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The vesicles were more severe on the erythematous to violaceous bases, as shown in Figure 1.
Right ulnar sensory nerve conduction study (NCS) showed no response (yellow highlighting).
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Right ulnar sensory nerve conduction study (NCS) showed no response, as shown in Figure 2.
Right 2-channel ulnar motor nerve conduction study (NCS) recorded at the abductor digiti minimi (ADM) and first dorsal interosseous (FDI) muscles, respectively. This demonstrates decreased ADM compound motor action potential (CMAP) amplitude (yellow highlighting) and severely decreased FDI CMAP amplitude (normal ulnar CMAP amplitude in our laboratory is >=5.0 mV) with a slight decrease in motor nerve conduction velocity (NCV) (yellow highlighting), which can be concluded as axonal involvement of motor fibers, more severe in FDI than ADM muscles.
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Right ulnar motor NCS showed normal distal motor latency, but also a marked decrease in compound motor action potential (CMAP) amplitude with mild slow motor nerve conduction velocity (NCV), as shown in Figure 3.
Right median motor nerve conduction study (NCS) recording at abductor pollicis brevis (APB) muscle demonstrated normal compound motor action potential (CMAP) amplitude (normal median CMAP amplitude in our laboratory is >=5.0 mV) with normal motor nerve conduction velocity (NCV) (green highlighting).
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Right median motor NCS showed normal distal motor latency and CMAP amplitude, as shown in Figure 4.
Right claw hand deformity (metacarpophalangeal (MCP) joint hyperextension and interphalangeal (IP) joint slightly flexion) in resting position (A) and after wearing a static figure-of-eight splint for MCP joint flexion (B).
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We prescribed occupational therapy treatment including kinetic activities with fine motor training of the right hand and a static hand splint for MCP joint flexion, as shown in Figure 5, which facilitated synchronized finger flexion to help the patient return to her work using a keyboard for typing.