Klumpke paralysis
Encyclopedia
Named after Augusta Déjerine-Klumpke
, Klumpke's paralysis (or Klumpke's palsy or Dejerine-Klumpke palsy) is a variety of partial palsy
of the lower roots of the brachial plexus
. 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. (see picture - click to enlarge).
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 and the flexors of the wrist and fingers". Forearm pronators and wrist flexors may be involved, as may dilators of the iris and elevators of the eyelid (both of which may be seen in the case of associated Horner's Syndrome
). The classic presentation of Klumpke's palsy is the “claw hand” where the forearm is supinated and the wrist and fingers are 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
. The most common aetiological mechanism is caused by a traumatic vaginal delivery, necessitated by shoulder dystocia
. 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 the abducted arm, as with an infant being pulled from the birth canal by an extended arm above the head or with someone catching himself by a branch as he falls 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
.
An easy way to remember Klumpke paralysis (or Klumpke's Palsy) is by remembering the phrase "Klumpke the monkey hung from a tree", as a method of injury is catching oneself on a tree branch when falling.
, paralysis
of intrinsic hand muscles, and ulnar nerve
distribution numbness. Involvement of T1
may result in Horner's syndrome
, with ptosis
, and miosis
.
It can be contrasted to Erb-Duchenne's palsy
, which affects C5
and C6
.
Augusta Déjerine-Klumpke
' was an American and the first woman to be an intern in a Parisian hospital. She married Joseph Jules Dejerine and was known for a treatise about neuroanatomyKlumpke paralysis is named for her.-Further reading:...
, Klumpke's paralysis (or Klumpke's palsy or Dejerine-Klumpke palsy) is a variety of partial palsy
Palsy
In medicine, palsy is the paralysis of a body part, often accompanied by loss of sensation and by uncontrolled body movements, such as shaking. Medical conditions involving palsy include cerebral palsy , brachial palsy , and Bell's palsy ....
of the lower roots of the brachial plexus
Brachial plexus
The brachial plexus is a network of nerve fibers, running from the spine, formed by the ventral rami of the lower four cervical and first thoracic nerve roots...
. 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. (see picture - click to enlarge).
Presentation
Klumpke's paralysis is a form of paralysis involving the muscles of the forearm and hand, resulting from a brachial plexus injuryBrachial plexus injury
The brachial plexus is a network of nerves that conducts signals from the spinal cord, which is housed in the spinal canal of the vertebral column , to the shoulder, arm and hand. These nerves originate in the fifth, sixth, seventh and eighth cervical , and first thoracic spinal nerves, and...
in which the eighth cervical (C8
C8
C8, C08, C.VIII or C-8 may refer to:* C-8 Buffalo, a military transport aircraft* C8 complex, three proteins involved in the complement system...
) and first thoracic (T1)
Thoracic nerves
The thoracic nerves are the spinal nerves emerging from the thoracic vertebrae. Branches also exit the spine and go directly to the Sympathetic Chain Ganglia of the Autonomic Nervous System where they are involved in the functions of organs and glands in the head, neck, thorax and abdomen.-Anterior...
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 and the flexors of the wrist and fingers". Forearm pronators and wrist flexors may be involved, as may dilators of the iris and elevators of the eyelid (both of which may be seen in the case of associated Horner's Syndrome
Horner's syndrome
Horner's syndrome is the combination of drooping of the eyelid and constriction of the pupil , sometimes accompanied by decreased sweating of the face on the same side; redness of the conjunctiva of the eye is often also present...
). The classic presentation of Klumpke's palsy is the “claw hand” where the forearm is supinated and the wrist and fingers are 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
Childbirth is the culmination of a human pregnancy or gestation period with the birth of one or more newborn infants from a woman's uterus...
. The most common aetiological mechanism is caused by a traumatic vaginal delivery, necessitated by shoulder dystocia
Shoulder dystocia
Shoulder dystocia is a specific case of dystocia whereby after the delivery of the head, the anterior shoulder of the infant cannot pass below the pubic symphysis, or requires significant manipulation to pass below the pubic symphysis. It is diagnosed when the shoulders fail to deliver shortly...
. 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 the abducted arm, as with an infant being pulled from the birth canal by an extended arm above the head or with someone catching himself by a branch as he falls 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
Erb's palsy is a paralysis of the arm caused by injury to the upper group of the arm's main nerves, specifically the upper trunk C5-C6 is severed. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5-C8, and T1. These injuries arise most commonly, but not...
.
An easy way to remember Klumpke paralysis (or Klumpke's Palsy) is by remembering the phrase "Klumpke the monkey hung from a tree", as a method of injury is catching oneself on a tree branch when falling.
Symptoms
Symptoms include claw handUlnar claw
A hand imitating an ulnar claw created by distal ulnar lesion or papal hand of a proximal median nerve lesion. The metacarpophalangeal joints of the 4th and 5th fingers are extended and the Interphalangeal joints of the same fingers are flexed....
, paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
of intrinsic hand muscles, and ulnar nerve
Ulnar nerve
In human anatomy, the ulnar nerve is a nerve which runs near the ulna bone. The ulnar collateral ligament of elbow joint is in relation with the ulnar nerve. The nerve is the largest unprotected nerve in the human body , so injury is common...
distribution numbness. Involvement of T1
Thoracic nerves
The thoracic nerves are the spinal nerves emerging from the thoracic vertebrae. Branches also exit the spine and go directly to the Sympathetic Chain Ganglia of the Autonomic Nervous System where they are involved in the functions of organs and glands in the head, neck, thorax and abdomen.-Anterior...
may result in Horner's syndrome
Horner's syndrome
Horner's syndrome is the combination of drooping of the eyelid and constriction of the pupil , sometimes accompanied by decreased sweating of the face on the same side; redness of the conjunctiva of the eye is often also present...
, with ptosis
Ptosis (eyelid)
Ptosis is a drooping of the upper or lower eyelid. The drooping may be worse after being awake longer, when the individual's muscles are tired. This condition is sometimes called "lazy eye", but that term normally refers to amblyopia...
, and miosis
Miosis
Miosis is the constriction of the pupil of the eye to two millimeters or less...
.
It can be contrasted to Erb-Duchenne's palsy
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 upper trunk C5-C6 is severed. These form part of the brachial plexus, comprising the ventral rami of spinal nerves C5-C8, and T1. These injuries arise most commonly, but not...
, which affects C5
Cervical spinal nerve 5
The cervical spinal nerve 5 is a spinal nerve of the cervical segment..It originates from the spinal column from above the cervical vertebra 5 ....
and C6
Cervical spinal nerve 6
The cervical spinal nerve 6 is a spinal nerve of the cervical segment..It originates from the spinal column from above the cervical vertebra 6 ....
.