Klumpke’s palsy, also known as either Klumpke’s paralysis or Dejerine-Klumpke palsy, is a type of brachial palsy that affects newborn babies. It is caused by an injury to the brachial plexus in which the first thoracic nerve (T1) and the eighth cervical nerve (C8) are injured before or after they have joined to form the lower trunk. This type of injury can occur during a difficult vaginal delivery and is one of the conditions that trigger Horner’s syndrome.
What Causes Klumpke’s Palsy?
Named after Augusta Dejerine-Klumpke, a French doctor who wrote the first widely-disseminated reports on the condition, Klumpke’s palsy is a partial paralysis that affects the muscles of a baby’s hand and forearm. Per the National Institute of Health’s Office of Rare Diseases (ORD), Klumpke’s palsy is caused by difficulties in childbirth. It usually occurs during difficult vaginal deliveries, especially in situations where the mother is small and the baby has a large birth weight. In birth injury cases, damage to the C8 and T1 nerves results when a doctor pulls the baby from the birth canal by an extended arm above the baby’s head. If the extraction is done too roughly, this results in several types of injuries to the lower brachial plexus.
According to the National Institute of Neural Disorders and Stroke (NINDS), there are four types of brachial plexus injuries:
- Avulsion, in which the nerve is severed from the spine
- Rupture, in which tearing of the nerve occurs but not at the spine
- Neuroma, in which the injured nerve has healed but can’t transmit nervous signals to the arm or hand muscles because scar tissue has formed and puts pressure on it
- Neuropraxia or stretching, in which the nerve has suffered damage but is not torn
Similar injuries that affect the upper brachial plexus cause Erb’s palsy.
Though most cases of Klumpke’s palsy are associated with birth injuries, older children and adults can become afflicted if they injure the C8 and T1 nerves, particularly when they fall from a tree and reach for a tree branch to break the fall.
According to the Mayo Clinic, sports activities, such as football or wrestling may also cause brachial plexus injuries in older children and adults. Depending on the type of injury sustained, the effects may be mild, such as the electric shock-like sensations known as “stingers” or “burners.” These cause either a sudden burning sensation that runs down the affected arm. They may also cause a temporary numbness of the arm and/or hand.
According to the St. Louis Children’s Hospital/Washington University School of Medicine’s Brachial Plexus Center, the prevalence of all brachial plexus injuries, including Klumpke’s palsy, is 0.2-2.5/1,000 births.
Klumpke’s palsy affects the hand’s intrinsic muscles and the flexors of the wrist and fingers. Depending on the type of injury to the brachial plexus, symptoms vary from mild to severe. The most severe physical manifestation of Klumpke’s palsy is the “claw hand,” where the affected forearm tends to lie flat and the wrist and fingers are tightened.
Other symptoms of Klumpke’s palsy include:
- Severe pain
- C8/T1 Dermatome distribution numbness
- Weakness or lack of ability to use specific muscles of the shoulder, arm. or hand.
- Limp or paralyzed arm
- Stiff joints
- Atrophy of the muscles
- No feeling or sensation in the affected arm or hand
- Drooping of the eyelids on the opposite side of the face (ptosis and miosis), also known as Horner’s syndrome
Complications and Prognosis
Most cases of Klumpke’s palsy are a result of injuries caused by neuropraxia, the most common brachial plexus injury. In many cases, a baby can recover from this type of injury within six months. Per the NINDS statistics on brachial plexus injuries, patients who suffer from neuropraxia-related Klumpke’s palsy recover on their own with 90-100% return of arm and hand function.
In more severe cases of brachial plexus injuries, however, the consequences may last for years or even result in lifelong disabilities of the arm, hand, or fingers. This is especially true in situations where avulsion takes place and permanently damages the T1 and C8 nerves. In some cases, surgery may be used to remove scar tissue from the affected nerves to improve their function.