KLUMPKE’S PARALYSIS

* Paralysis involving the muscles of the forearm and hand.

* Resulting from a brachial plexus injury.

* Eighth cervical (C8) and first thoracic (T1) nerves are injured either before or after they have joined to form the lower trunk. 

Site of injury:

* Lower trunk of the brachial plexus.

Cause of injury:

* Undue abduction of the arm, as in clutching something with the hands after a fall from a height, or sometimes in birth injury.

Nerve roots involved: 

* Mainly T1 & partly C8.

Muscles paralysed:

1. Intrinsic muscles of the hand (T1).

2. Ulnar flexors of the wrist & fingers (C6).

3. Deformity (position of the hand).

* Claw hand due to the unopposed action of the long flexors & extensors of the fingers.

In a claw hand there is:

hyperextension at the metacarpophalangeal joints and

flexion at the interphalangeal joints.

Disability:

1. Claw hand

2. Cutaneous anaesthesia & analgesia in a narrow zone along the ulnar border of the forearm & hand.

3. Horner’s syndrome if T1 is injured proximal to white ramus communicans to first thoracic sympathetic ganglion.

* There is ptosis, miosis, anhydrosis, enopthalmos, & loss of ciliospinal reflex- may be associated. 

4. Vasomotor changes: The skin area with sensory loss is warmer due to arteriolar dilation.

* It is also drier due to the absence of sweating as there is loss of sympathetic activity.

5.Trophic changes: Long standing case of paralysis leads to dry & scaly skin.

* The nails crack easily with atrophy of the pulp of fingers.