Klumpke's Palsy

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1- Introduction

2- Anatomical Overview

3- Procedure

4- purposes 


Injuries to inferior parts of the brachial plexus (Klumpke paralysis) are much less common. Inferior brachial plexus injuries may occur when the upper limb is suddenly pulled superiorly—for example, when a person grasps something to break a fall or a baby’s upper limb is pulled excessively during delivery. These events injure the inferior trunk of the brachial plexus (C8 and T1) and may avulse the roots of the spinal nerves
from the spinal cord. The short muscles of the hand are affected, and a claw hand results.
© image from moore clinically oriented anatomy

Anatomical Overview

Anatomy Involved

  1. Brachial Plexus:

    • Lower Trunk: Formed by the union of the C8 and T1 nerve roots.
    • Divisions and Cords: The lower trunk splits into anterior and posterior divisions, contributing to the medial cord of the brachial plexus.
  2. Nerves Affected:

    • Ulnar Nerve: Arises primarily from C8 and T1 nerve roots.
    • Median Nerve: Partially arises from C8 and T1 nerve roots.
    • Medial Cutaneous Nerve of the Arm and Forearm: Provides sensory innervation to the skin of the medial arm and forearm.
  3. Muscles Affected:

    • Intrinsic Muscles of the Hand: Including the interossei, lumbricals (to the ring and little fingers), hypothenar muscles (flexor digiti minimi, abductor digiti minimi, opponens digiti minimi), and adductor pollicis.
    • Flexor Carpi Ulnaris: A muscle in the forearm that flexes and adducts the hand at the wrist.
    • Flexor Digitorum Profundus (medial half): Flexes the distal phalanges of the ring and little fingers.
© image from color atlas of anatomy


  • Conservative Management:

    • Physical Therapy: To maintain joint mobility and muscle strength, and to prevent contractures.
    • Occupational Therapy: To improve functional use of the hand and arm.
    • Pain Management: Use of medications to control neuropathic pain.
  • Surgical Intervention:

    • Nerve Repair or Grafting: In cases of severe nerve damage or avulsion.
    • Tendon Transfers: To restore hand function by re-routing tendons from functioning muscles.
    • Decompression Surgery: For cases due to thoracic outlet syndrome or tumors.
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