Klumpke's paralysis is a variety of partial

palsy Palsy is a medical term which refers to various types of paralysisDan Agin, ''More Than Genes: What Science Can Tell Us About Toxic Chemicals, Development, and the Risk to Our Children;; (2009), p. 172. or paresis, often accompanied by weakness a ...

of the lower roots of the

brachial plexus The brachial plexus is a network () of nerves formed by the anterior rami of the lower four cervical nerves and first thoracic nerve ( C5, C6, C7, C8, and T1). This plexus extends from the spinal cord, through the cervicoaxillary canal in t ...

. p.1046 The brachial plexus is a network of spinal nerves that originates in the back of the neck, extends through the axilla (armpit), and gives rise to nerves to the upper limb.Warwick, R., & Williams, P.L. (1973). pp.1037-1047 pp.370-374 pp.76-77Shenaq S.M., & Spiegel A.J. Hand, Brachial Plexus Surgery. eMedicine.com. URL
http://www.emedicine.com/plastic/topic450.htm
Accessed on: April 13, 2007. The paralytic condition is named after Augusta Déjerine-Klumpke.

Signs and symptoms

Symptoms include intrinsic minus hand deformity, paralysis of intrinsic hand muscles, and C8/T1 Dermatome distribution numbness. Involvement of T1 may result in

Horner's syndrome Horner's syndrome, also known as oculosympathetic paresis, is a combination of symptoms that arises when a group of nerves known as the sympathetic trunk is damaged. The signs and symptoms occur on the same side (ipsilateral) as it is a lesion ...

, with ptosis, and

miosis Miosis, or myosis (), is excessive constriction of the pupil.Farlex medical dictionary
citing: ...

. Weakness or lack of ability to use specific muscles of the shoulder or arm. pp.576, 667 It can be contrasted to Erb-Duchenne's palsy, which affects C5 and C6.

Cause

Klumpke's paralysis is a form of paralysis involving the muscles of the forearm and hand, resulting from a

brachial plexus injury A brachial plexus injury (BPI), also known as brachial plexus lesion, is an injury to the brachial plexus, the network of nerves that conducts signals from the spinal cord to the shoulder, arm and hand. These nerves originate in the fifth, sixth, s ...

in which the eighth cervical ( C8) and first thoracic (T1) nerves are injured either before or after they have joined to form the lower trunk. The subsequent paralysis affects, principally, the intrinsic muscles of the hand (notably the

interossei {{short description, Muscles between certain bones Interossei refer to muscles between certain bones. There are many interossei in a human body. Specific interossei include: On the hands * Dorsal interossei muscles of the hand * Palmar interosse ...

, thenar and

hypothenar muscles The hypothenar muscles are a group of three muscles of the palm that control the motion of the little finger. The three muscles are: * Abductor digiti minimi * Flexor digiti minimi brevis * Opponens digiti minimi Structure The muscles of hypot ...

) and the flexors of the wrist and fingers (notably

flexor carpi ulnaris The flexor carpi ulnaris (FCU) is a muscle of the forearm that flexes and adducts at the wrist joint. Structure Origin The flexor carpi ulnaris has two heads; a humeral head and ulnar head. The humeral head originates from the medial epicondyle of ...

and ulnar half of the

flexor digitorum profundus The flexor digitorum profundus is a muscle in the forearm of humans that flexes the fingers (also known as digits). It is considered an extrinsic hand muscle because it acts on the hand while its muscle belly is located in the forearm. Together ...

).Page 512: Lower Radicular Syndrome (Klumpke Paralysis)
in: Klumpke palsy. Stedman's Dictionary. URL
http://www.emedicine.com/asp/dictionary.asp?exact=Y&keyword=Klumpke+palsy
. Accessed on: April 13, 2007. The classic presentation of Klumpke's palsy is the “claw hand” where the forearm is supinated, the wrist extended and the fingers flexed. If Horner syndrome is present, there is miosis (constriction of the pupils) in the affected eye. The injury can result from difficulties in

childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births glob ...

. The most common aetiological mechanism is caused by a traumatic vaginal delivery. The risk is greater when the mother is small or when the infant is of large weight. Risk of injury to the lower brachial plexus results from traction on an abducted arm, as with an infant being pulled from the birth canal by an extended arm above the head or with someone catching themselves by a branch as they fall from a tree. Lower brachial plexus injuries should be distinguished from upper brachial plexus injuries, which can also result from birth trauma but give a different syndrome of weakness known as

Erb's palsy Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the severing of the upper trunk C5–C6 nerves. These form part of the brachial plexus, comprising the ventral rami of spinal ner ...

. Other trauma, such as motorcycle accidents, that have similar spinal cord injuries to C8 and T1, also show the same symptoms of Klumpke's paralysis.

Diagnosis

Electromyography and nerve conduction velocity testing can help to diagnose the location and severity of the lesion. Otherwise, the diagnosis is one made clinically after a thorough neurologic exam.

Treatment

Treatment effectiveness varies depending on the initial severity of the injury. Physiotherapy is used to increase strength of muscle and improve muscle functions. Electrical modalities such as electric nerve stimulation can also be used. Occupational therapy to provide exercises and coping mechanisms to improve the patient's ability to perform activities of daily living. Goals of therapy are to improve tactile sensation,

proprioception Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...

, and range of motion. Acute treatment of a severe injury will involve repositioning and splinting or casting of the extremity.

Epidemiology

Klumpke Palsy is listed as a 'rare disease' by the Office of Rare Diseases (ORD) of the National Institutes of Health (NIH). This means that Klumpke palsy, or a subtype of Klumpke palsy, affects fewer than 200,000 people in the US population.

References

External links

{{Certain conditions originating in the perinatal period Birth trauma