Klumpke’s palsy, also known as Klumpke’s paralysis or Dejerine-Klumpke palsy, is a brachial plexus injury that usually affects newborns as a result of a birth injury. Brachial plexus injuries interfere with the network of nerves that sends impulses from the spine to the shoulder, arm, and spine. Depending on the severity of the nerve damage, some occurrences of Klumpke’s palsy disappear on their own, while the more severe cases require various forms of treatment.
A Brief Look at Klumpke’s Palsy
Brachial plexus injuries such as Klumpke’s palsy (which affect the lower half) and Erb’s palsy (which affects the upper half) result when the nerves in the brachial plexus are stretched, compressed, or torn. In older children and adults, these injuries are often caused by contact sports, several types of accidents, or falls. Klumpke’s palsy, for instance, can occur when someone climbs a tree, starts to fall, and injures the C8 and T1 nerves.
In newborn babies, Klumpke’s palsy and other brachial plexus injuries occur during a difficult vaginal delivery, especially if a doctor pulls the baby out by the arm and uses too much force.
Per the National Institute of Neural Disorders and Stroke (NINDS), these are the four types of brachial plexus injuries that cause Klumpke’s palsy:
- 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
Klumpke’s palsy is officially listed as a rare medical condition. According to the National Institute of Health’s Office of Rare Diseases, Klumpke’s palsy has a prevalence of less than 200,000 affected persons in the United States.
Treatment for Klumpke’s Palsy
In most cases of Klumpke’s palsy, the severity of the injury determines a doctor’s choice of treatment. As with other brachial plexus injuries, the most common form of injury that causes Klumpke’s palsy is stretching of the nerves or neuropraxia. This is the least severe injury and most babies who suffered neuropraxia during delivery often recover without treatment. Per the NINDS, many babies injured at birth improve or totally heal by the time they are three or four months old.
The three other major factors involved in the choice of treatment option are:
- Type of injury
- Time elapsed between the occurrence of the injury and the treatment
- Other existing conditions
Doctors have several treatment options available to help patients with Klumpke’s palsy. These include:
- Physical Therapy
Even in cases where the injury heals on its own, physical therapy assists in keeping the muscles and joints’ range of motion normal. Physical therapy also keeps muscles and joints to work properly and prevents stiffness in joints such as the shoulder, elbow, or wrist. Not only does physical therapy help speed up the healing process, but it also relieves the pain and discomfort caused by the injury.
Surgery to treat brachial plexus injuries is often necessary even in situations when a patient seems to be recovering well. Scar tissue often forms on top of the nerves and/or muscles during the healing process. This scar tissue interferes with the nerve’s ability to transmit signals from the central nervous system to the affected limb. The only way to restore the nerve’s functionality is to physically remove the scar tissue.
In cases where avulsion or rupture occurred, surgery is needed to repair the severe damage to the affected nerves in the brachial plexus. This is because the nerves, particularly the T1 and C8 nerves, have been cut or torn.
Surgeons have three methods to repair damage to the brachial plexus:
- Nerve graft, in which the damaged section of the brachial plexus is surgically removed and replaced with nerves excised from other parts of the patient’s body to restore the arm’s function
- Nerve transfer is a procedure used in cases where avulsion (total separation from the spine) occurred; a surgeon takes a secondary nerve that’s still connected to the spine and attaches it to the severed nerve
- Muscle transfer, in which a less important muscle or tendon is removed from another part of the body and attached to the injured arm if the muscles there deteriorate
Klumpke’s palsy often causes pain or a persistent burning sensation. Doctors often prescribe medications to relieve the pain caused by brachial plexus injuries, including topical ointments and prescription medications.